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Home My WebLink AboutUST REP. 1/19/1996 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........ ~,,~,,;,~?'~??7777!'?ii!~,~,~ ....... This permit is issued for the following: ~ , .,,,47 ii"'J"i/,/~, :~,:J.~:J~:L:,LLL~.~ii:.?,,..,,':~,~El~Hazardous Materials Plan · ~:4~"?'?~i'"i'.:~i~::~.!:?~:?'!::;i i!i iiiii:::::: iiiiii~,ili~i~erground Storage of Hazardous Materials PERMIT ID" 015-0214)00330 ?i?~!il !~..~i;,~i!;il};iiii:,ii!!ii!i? !!!? ~ii i !i ?!!! :::! i!iiiil}~:=~!!i~kii~pagement Program TEXACO STAR MART #0988 LOCATION 3621 ·/~ ~E~ ...... ~ PIPING PIPING PIPING PIPING TANTA H~RDOUS SUBSTANCE CAPACIT~ ........ ~"*"'*::'~' '" ~':'~ IN~'~ '.]~ ~M~ERIAL MO~ITgR; ? ONt~OR TYPE TYPE METHOD ONITOR ~'"*"*"~ ~"' ~:~Jt~' '~ ~J~4L~3..,? /d.: .......... "h`"~ ..... ~001 UNLEADED GASOLINE ~"GAL '~":':..5/20/9~~ ~ F MIR,.,~;';'" ~T"~]~ SW GAL PRESSURE LTT 4"l, ~ UNLEADED PLUS GASOLINE 100000.~::GAL _75120/97 'D~"' F < ~002 MJb:'" '~ SW GAL PRESSURE LTT Il 00030003 SUPER UNLEADED GASOLIN 100,000.00~:GAL ~?' '5120i9~/:' DW F ..... ~"',;'~',, .=~::MiR ..... ?~'"~ SW GAL PRESSURE LTT 0004 II0004 DIESEL ~2 100,000.00 ~A~:,~, ?,:;;,~51~;~;: :;:~ :~,,.~- iF,,, '~;::~:;.];:[;;~ ~;;:~;~; ~tR .... ~,~:"::~.L~ ~'~T SW GAL PRESSURE LTT Is~ by: O~CE OF E~RON~AL S~ 1715 Chewer Ave., 3rd Floor ~ Office of ~~1 S~i~ · B~e~fiel~ CA 9~01 Voice (805) 32~979 F~ (805)~6-0~76 Expiration Date: ~n~ ~O~ ~OOO City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: TEXACO STAR MART 110988 Permit 11015-021-000330 3621 California Ave Bakersfield, California 93309 TION ~ ~ Bakersfield Fire Dept. HAZARDOUS MATERIALS IN ~c_z OF ~.,vw~o~M~.~vr.~. . s~.~ wc~s ~ , ~ - 1715 Chester Ave. ' ~ B~ersfield, CA 93301 Date Completed t//? Business Name: ~-~,~r'.O ~ )o. V '5'1~:~/ Loca~on: --~ 9-~ ~ ~ ~ ~ Business Iden~flca~on No. 215-000 ~.g~ Cop of Business Plan) Sta~on No. ~ -~O)~ Shift Inspector /~ ~val Time: Depadure Time: Inspec~on ~me: Adequate Inadequate Adequate Inadequate Address Visable ~ Fl Emergency Procedures Posted Correct Occupancy ~ (3 Containers Propedy Labled {;~ [] Verification of Inventory MaterialsE3' [] Comments: Verification of Quantities ~ [] --- Verification of Location ~ [] _. Verification of Facility Diagram[]f [] Proper Segregation of Material ~ [] Housekeeping ~" r'l , Fire Protection Comments: Electrical ~'" [] Comments: Verification of MSDS Availablity ~ [] Number of Employees: UST Monitoring Program ~/' [] Comments: Verification of Haz Mat Training ~ [] Pe~its []/ [] Comments: Spill Control ~ [] Hold Open Device Verification of Hazardous Waste EPA No. Abbatement Supplies and Procedures I~ r-I Proper Waste Disposal ~ [] Comments: Seconda~/Containment Secudty Special Hazards Associated with this Facility: Violations: · , ~/,/ .. /~ / ,,,_,_.__ All Items O.K Busine~ O~anafl~ PRINT NAME SIGNATURE Correc~on Needed ~ite-H~ Mat Div. Yello~Station Copy Pink-Business C~y UNDERGROUNdtSTORAG KINSPEC ION -.-; ',, i ......... Bakersfield Fire Dept.' -, - i::i:i! . Bakersfieid, CA 93301 FACILITY NAME "'"~~ t,4,)~,-., ,.~"i.~,~;~.,, BUSINESS I.D. No. 215-000 FACILITY PHONE No. 5 ~.~- ~~ ,o~ ,o~ ,D~ INSPECTION DATE t //) c~ //~i (~ Product product Product TIME IN TIME OUT ~o~e-/~L Inst I~te Inst Date ° Inst Date INSPECTION TYPE: V'~-. '"7~-5 - '~5~ / cir~.~ j Size Size Size ROUTINE i FOLLOW-UP i ,9,,/q~),-~ ~ ~ I :~ ~ ~',~ REQUIREMENTS yes no n/a yes no n/a yes no n/a 1 a. Forms A & B Submitted ~ lb. Form C Submitted lc. Operating Fees Paid ~" 1 d. State Surcharge Paid ~ ~" 1 e. Statement of Financial Responsibility Submitted ~ lf. Written Contract Exists between Owner & Operator to Operate UST ~ ~ /,/"'- 2a. Valid Operating Permit ~-- 2b. Approved Written Routine Monitoring Procedure ~ ~-' ~ 2c. Unauthorized Release Response Plan ?/I //~c~" ~'~ ¢'"' 3a. Tank Integrity Test in Last 12 Months ~ ! 3b. Pressurized Piping Integrity Test in Last 12 Months ~-- ~ ~ ' 3c. Suction Piping Tightness Test in Last 3 Years ,,~ ~-' . 3d. Gravity Flow Piping Tightness Test in Last 2 Years ~ 3e. Test Results Submitted Within 30 Days ~ 3f. Daily Visual Monitoring of Suction Product Piping .... , ~ 4a. Manual Inventory Reconciliation Each Month ~ 4b. Annual Inventory Reconciliation Statement Submitted ,-.-' '-" 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks 6. Monthly Statistical Inventory Reconciliation Results 7. Monthly Automatic Tank Gauging Results ~ 8. Ground Water Monitoring ~ 9. Vapor Monitoring ~'~ 10. Continuous Interstitial Monitoring for Double-Walled Tanks 11. Mechanical Line Leak Detectors z,--'"- 12. Electronic Line Leak Detectors ,~ ~ ~ ~-~ 13. Continuous Piping Monitoring in Sumps 14. Automatic Pump Shut-off Capability ,/" 15. Annual Maintenance/Calibration of Leak Detection Equipment ,,z//,,/./~.~/~.c~-'~ ¢.,. ,-- 16. Leak Detection Equipment and Test Method~ listed in LG-113 Series ~,- 17. Written Records Maintained on Site ~ 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days "'/' ~"" '//'" 19. Reported Unauthorized Release Within 24 Hours 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection ~" 22. Secured Monitoring Wells 23. Drop Tube - ~ I RE-INSPECTION~ /.. ~.~DATE ,,..4 .,,~/, -~ RECEIVED BY: -~ FD 1669 (rev. 9/~ Station Building -' N ) Planter ,>, Map not to Scale Canopy ¢~, Texaco California SITE LOC; Bdkersfield, CA DESCRIPTION, _~ite map w/ excovQtions Impacted Soils ~ MJW p/13/89I , I .... "'' .................. 11 I III I IIIII I I _ 11 Jl II -- -- TANK PIT EXCAVATION CROSS SECTIONAL 'VIEW SECTION A - A' , A' ~t A / ~ / - ~ / ',. ~ ' ~ , ' 0 ~ ~ I '~ ~ ~ I I I~ ~ ., , ,,, .... ..,.-~ ~/,...._ ...... ,.,.' ..,......}..,,, / roximofe Extent ~ ( of [xcovotion ',-, .~ ~ ..... Texaco California ,1~50-4002 ~ Sample LocaTion w/ I.D. California and Real, Bakersfield · ' "D( ')C~iP T IBf~ ..... Tqnl< Pit Cross Section IL: ...... ~: , ~, ,~, LEGEND QQO aa aa ~- Boring Location Regular Planter ooo Unleaded I--1 B 3~i)- ' ~B1 .~ ~B4 000 Premium I--1 Scale (approximate) Curb 8 024 68 ooo Diesel l--1 Feet Is~rE' f ITexaco California J,so 4002 B2 j SITE Lnc, ~621 California Ave. ' J Bakersfield, CA J Boring Location . DRA~N ~Y~ DATE, APPRDVED TLP 2/21/90 ~SSOCZ~TED ENgIRONflENT~L SYSTEMS -'0-- o 'o '0 0 0 0 0 9SL,0 0 0 'OK S/UL R/ULRE6, ~ tOKtOK O0 VENTS' O0 TEXACO 362i CALIFORNIA AVE W0,#i3854 I"sil;eLayoui;FoP : T~X'ACOUSA BAKERSFIELI)"FCAm i i I II I II IIIIII IIII _ _ _ ", -- 'TANK PiT EXCAVATION CROSS SECTIONAL VIEW SECTIONB - ~ I1 II I1 II -0 11 II II ,. ' II ~ Approximate Extent ~ 20 of Excavation Texaco Colitornio l~S0-Zob3 SITE LOC: · ~8 Sample Location w/ I.D. Colifornfa and Real, Bokersfielo ~ESC~PT 10N: Tank Pit Cross Section ujw ot~ 2/sq . __ I II I I III I I Il I - A ' .- curb I \" Approxhnofe Limif~ of Excavation ","", ' t ~ of Excavation i ross Section Lines Vent Lines i ~ ~ ~ottom Samples ~ ~ Sidewall Sample .Texaco Cnlifornia !2 California Avenue ~ckersf~eJd, I III Station Building Planter Canopy ~ Map not to Scale SITE, JDB ~ Texaco California SITE LOC: Bakersfield, CA DESCRIPTION~ ~ite mop w/' excovotions lmpacLed Soils MJW p/15/89 _ GRflUNDWATrlR I J LLLLLLLLLLLLLLLLLLL~L_JL_JI TECHNDLrlGY I I ! I I IIII I II III I] I I .............. - -' I TANK PIT EXCAVAI"ION CROSS SECTIONAL 'VIEW SECTION A - A' II II I I II .--0 I~ Diesel ~ ~ /rSuprem" Unlea6.d I [ ~'1 Unleede,~ Ii It gula~ ii . Approximate Extent ~ ~0 of Excavation lexaco California [~so-4oo2 SITE ~ Sample Location w// t.D. ~alifornia and Real, Bakerstield Tank Pit Cross Section February 9, 1999 F~RE C.~EF Texaco Star Mart #0988 ~ON FRAZE 3621 California Ave t~MJn~s'maTnn~s,:awc,:s Bakersfield, CA 93309 2101 'H' Street Bakers~eld, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 RE: Compliance Inspection SUPPaESSlO. SERVICES Dear Underground Storage Tank Owner: 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 The city will start compliance inspections on all fueling stations within the city limits. This inspection will include business plans, PREVENTION SERVICES underground storage tanks and monitoring systems, and hazardous 1715 Chester Ave. Bakersfield, CA 93301 materials inspection. VOICE (805) 326-3951 FAX (805) 326-0576 To assist you in preparing for this inspection, this office is ENVIRONMENTAL SERVICES enclosing a checklist for your convenience. Please take time to read this 1715 Chester Ave. Bakersfield. CA 93301 list, and verify that your facility has met all the necessary requirements to VOICE (805) 326-3979 be in FAX (805) 3260576 compnance. mn.,.o Dnns~o. Should you have any questions, please feel free to contact me at 5642 Victor Ave. aakersne~d, CA 933O8 805-326-3979. VOICE (805) 399-4697' FAX (805) 399-5763 Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure TEXACO STAR MART SCALE: 1"=20' LEGEND ~se APPROXIMATE LOCATION OF SOIL SAMPLES 12/17/98 .,,~...~//...- A.C. PARKING LOT ~'~'-"--~' ~ 1,000 GALLON WASTE OIL TANK REMOVED / CONCRETE ~ 12/17/98 XPRESS LUBE uJ u.I t- I- u.I 0 CONCRETE V-GUTTER SOIL SAMPLE LOCATION MAP II CONSOLIDATED TESTING LABORATORIES INC. 60.3 E. WORTH PORTERVILLE,CA JOB LOCATION: TEXACO EXPRESS DATE DRAWN: 1/5/99 5621 CALIFORNIA AVENUE DRAWN BY: D. STEPHENS BAKERSFIELD, CA JOB NUMBER: 4..304-98 REVISED: BAKERSFIELD FIRE DEPARTMENT February 13, 1998 FIRE CHIEF MICHAELR. KELLY Texaco Star Mart #0988 3621 California Avenue AI)MINI$11~JIV[~R~ICr~ Bakersfield, CA 93309 2101 'H' Street Baker~f~d, CA 93,301 (805) 326-3941 FAX (805) 395-1~19 sum~:~ s~:~'~:~ RE: "Hold Open Devices" on Fuel Dispensers 2101 "fl' Street Bake~fleldo CA 93,301 (805) 3264941 Dear Underground Storage Tank Owner: FAX (805) 395-1349 ~'vmnON say,fa The Bakersfield City Fire Department will commence with our annual 1715 C~er Ave. Underground Storage Tank Inspection Program within the next 2 weeks. Bake~fleld, CA 93301 (805) 326-3951 FAX (806)326-0576 The Bakersfield City Fire Department recently changed its City Ordinance ENVIRONMENTAL.~I~ICF.$ concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire 1715Chester Ave. Department now requires that "hold open devices" be installed on all fuel Bakersfield, CA 93301 (805) 326-3979 dispensers. The new ordinance conforms to the State of California guidelines. FAX (805) 326-0576 The Bakersfield Fire Department apologies for any inconvenience this 11~AINING DIVISION 5642 Victor Street may cause you. Bakersfield, CA 93308 (805) 399-4697 FAXes) 3~-s76~ Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey ~ T®~eco R®finir~ end [~,,r~erk®tBn~] linc P O Box 1476 Bakersfield CA 93302 805 326 4200 May 22, 1994 ILl I~V ~ ~ // ~I? City of Bakersfield Fire Department ....... ~~ ~// Hazardous Materials Division 2130 G Street Bakersfield, California 93301 Ref: Permit ~330 Texaco Retail Facility ID No. 016674 3621 California Avenue & Real Road Bakersfield, California Gentlemen: Please be advised that subject Texaco retail facility was temporarily closed on May 19, 1997 for the replacement of the underground storage tanks. For your files, enclosed please find completed Forms A & B for the removal of the old single-wall steel underground tanks and the replacement with double-wall fiberglass underground tanks Form C will be forwarded to your office upon completion of the project. If this office may be of any additional assistance, or if additional information is required, please contact the undersigned at (805) 326-4326. Sincerely, TEMCO REFINING AND ~ETING INC. F. G. LONG EH&S Coordinator. enclosure Building on a Tradition of Quality STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE I MARKONLY [--] 1NEWPERMIT J-~ 3 RENEWAL PERMIT ,~5 C~E OF INFORMATION [~ 7 PERMANENTLY CLOSED SITE ONE ITEM ~ 2 INTERIM PERMIT [----J 4 AMENDED PERMIT 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS- (MUST BE COMPLETED) DBAOR FACILITY NAME ,TEXACO REFINING AND NL~RKE.]'!.NG ADDRESS NEAREST CROSS STREET, PARCEl ~ (OPTIONAL) ,/ 8OX ~C TO IN0iCATE ORPORATION ~ iNDIVIDUAL I---I PARTNERSHIP [--"] LOCAL-AGENCY [~] COUNTY-~GENCY [~] STATE-AGENCY [~] FEDERAL.~GENCY D~STRICTS EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) · optional DAYS: NAME(LAST. FIRST) /' PN~ONE# WITH AREACODE DAYS: NAME(LAST. FIRST) ~_ ~,~.~.~ -- NIGHTS: NAME ~-~ST, FIRST) J ~ ~---'15HO~,E # WITH AREA CODE NIGHTS: NAME-{LAST. FIRS~ II. PROPERTY OWNER INFORMATION' (MUST BE COMPLETED) NAME CAR O AOORESSIN ORMAT,ON MAILING OR STREET ADDRESS ~/ ~[ 1~ indicate ~IDIVIDUAL ~ LOCAL-AGENCY E~ STATE.AGENCY III. TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER ,TE}~'~CO REFININO AND MARKETING tNC, I CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ¢' Ix= 13 indicate [--'1 INDIVIDUAL E~ LOCAL-AGENCY ~ STATE-AGENCY J'FP e T'- P'-,ONE,W,T.A,EACODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 323-9555 if questions arise, TY(TK} HQ ~-~-b Iololz. I/171 ... · v. PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED) -IDENTIFY'THE METHOD(S) USED I ,/ box t3 indicate ~,.1 SELF-INSURED [~ 2 GUARANTEE [~] 3 INSURANCE ['--] 4 SURETYSOND l..J5 LETTER OF CREDiT ~] 6 EXEMPTION [~] 99 OTHER VI. LEGAL NOTIFICATION AND BILLING ADDR ESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPUCANT'S NAME (PRINTED & SIGNATURE) ~~ &- ~-'~0~~'~ ~/~'~'APPLICANT'S TITLE (~ OOY~'J'~/'i~ IDATE MONTM/DAY/YEAR LOCAL AGENCY USE ONLY COUNTY # JURISDICTION # FACILITY # LOCATION CODE - OPTIONAL ICENSUS TRACT · - OPTIONAl. SUPVlSOR - DISTRICT COOE- OPTIONAL THIS FORM MUST BE ACCOMPANIED BY.AT LEAST (1) OR MORE PERMIT APPLICATION . FORM B~ UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY, FORM A (5-gl) FOR0033A-5 STATE OF CAUFORN]A STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [~ 1 NEW PERMIT [~ 3 RENEWAL PERMIT ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBA OR FAC.L,T .AME WHERE TA.K ,S ,.STALLED: I. TANK DESCRIPTION COMPLETE ALL ~TEUS -- SP~C~FV ~F UNKNOWN A, OWNER'S TANK I.D.~ B. MANUFAC~RED BY: C. QATE [NSTALLEO (MO/OAYNEAR) ~-- ~0 --~ ~ D. TANK C~ACI~ IN G~LONS: II. TAN K CONTRAS ~F A-1 IS MARKED. COMPLETE ITEM C. A. ~1 MOTOR VEHICLE FUEL ~ 4 OIL B. C. ~ laREGULAR ~ 3 DIESEL ~ 6 AVIATION GAS - UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 OTHER (DESCRIBE IN ITEM O. BELOW D. IF (A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WITH E~ERIOR LINER ~ 95 UNKNOWN SYSTEM ~ 2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAULTED TANK) ~ 99 OTHER B. TANK ~ 1 BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERGLASS ~ 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERI~ ~ 5 CONCRETE ~ 6 POL~INYL CHLORIDE ~ 7 ALUMINUM ~ 8 ~om/~ METHANOL COMPATIBLEW/FRP (Prim~ryTank) ~ 9 BRONZE ~ 10 ~LVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER ~ 1 RUBBER LINED ~ 2 ~D LINING ~ 3 EPO~ LINING ~ 4 PHENOL~ LINING C. INTERIOR ~ 5 GLASS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 1~ METHANOL ? YE~ NO~ D. CORROSION ~ I POLYETHYLENE WRAP ~ 2 COATING ~ 3 VINYL WR~ ~ 4 FIBERGLAS REINFORCED PLASTIC PROTECTION ~ 5 CATHODIC PROTECTION ~ 91 NONE ~ 95 UNKNOWN ~ 99 O~ER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION A~ 2 PRESSURE A U 3 GRAVI~ A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A~ 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POL~INYL CHLORIDE(PVC)A U 4 FIBERGLAS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A~8 10~/~ ME~ANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~1 AUTOMATIC LiNE LEAK DETECTOR ~ 2 LtNE TIGHTNESS TESTING ~ 3 tNTERSTIT~L MONffORiNG ~ 99 OTHER V. TANK LEAK DETECTION ~ ~ 1 VISUAL CHECK ~2 INVENTORY RECONCILIATION ~ 3VAPORMONITORING~ 4 AUTOMATIO TANK GAUGING ~ 5 GROUND WATER MONITORING [ VI. TANK CLOSURE INFORMATION I 1. ESTIMATED DATE LAST USED (MO/DAY. R) 2. ESTIMATED OUANT,~ OFsuBSTANCE REMAINING GALLONS 3. WAS TANK FILLED WITHINERT MATERIAL ? YES ~ NO~ THIS FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT J APPLICANTS NAME D~ ~ DAT~ /~ LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSE S BELOW COUNTY ~ JURISDICTION ~ FACILITY I I I I I I I I I I I[11 t PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE AC~MP~IED BY A PERMff ~PECATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORO~ 1, One FORM "B" shall be completed R)r each tank for all ~V P~, PE~IF (]~WGUS, ~MOVAL~ and/or any 2 'Feds form should be compteled by ekhcr the PI~[tR,!~' A}PL~F or the [X}(~, AGI~Iqc~ iJ~4DI~R(}~OUND 3. Please typa or print clearly all requesled iaformat~on. 4. Usc a ha:d poini ~mdng instrumenL you are msMng 3 copies. .l. Mark an (X) i~ the box next to the item that besi describes the reason tile form is being compleied. 2. indicate the DBA or Facility name where lhe tank is installed. indicate o~'me~ tank ID ~* - If there is a tank number IBat is used by the ~er to identify the tank (ex. AB70789). Indicate rite name of the company that manuthcturcd the tank (ex. ACME TANK indicale the year file tank was installed (ex. 1987). Indicate the tank capacity in galkms (ex. %5,000 or 10,0OO A, 1. If MOTOR VEHICI,E FUEL, check box l and complete items B & C, 2. If not MOTOR VEItlCI,E FUEL, check the appropriate box in section A and complete items B & I% B.Check the appropriate box. C.Check the ty~ of MOTOR V[fltlCLE t'~EI, (if box t is checked in A). ?tint thc chemical name of the hxraOous substance stored in the tank and Ihe C.A,S.~. (Chemical Abstract ~ice :~umbcr), if bo: 1 is NOT checked in A. 1. Check only one item in ~PE OF SYSTEM. TANK MATER~SL, INhibitOR LINING and CORROSION PROTECHON. 2. if O'IIIER, print in the space provided. 1. Ckde ~ ii above ~ound; circle U if under~ound; and circle both if applicable. 2. ~f UNKNOWN, cimle; or if OTIIEK print in space p~Mded. 3. Indicate the LEAK D[rlT~CrlON s~tem(s) used to comply with the monitoring requirement for the piping. 1. indicate the LPAX DEli'ECl]ON system(s) used to comply Mth the monitoring requirements for the tank. 1. IfB'H~TED DATE IA~ USED - MO~t~FAR (Janua~, 1988 or 01/88). 2. F~qlMA'rED QUA~III'W of HAT~RI)()US SUBS*rANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED wrrH INERT MATEI~L? Check 'Yes' or 'NO'. Thc slate underground storage tank identification number is com~sed of the two digit county number, the three digit jurisdiction number~ the six digit facility number and the six digit tank number. ?[]m county and jurisdiction numb¢~ are predetermined and can be obtained by calling the State Board (916)73%~421. l~e hcitily number must be the same as shown in form %", tank/mmbcr may bc assigned by the local agency; however th~s number must be lmmcrical and cannot contain an alphabet. If ibc local agency prefe.m the State Board to assign the iaak number, please teave il blank. CiO STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOAfiD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] I NEW PERMIT [] 3 RENEWAL PERMIT ~5 CHANGE OF INFO~RMATION [~ 7 PERMANENTLY CLOSED ON SiTE ONE ITEM [] 2 INTERIM PERMIT [~] 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED OaA oR FAC~UT~ NA~E WHERE TA.K ~S ~.STALLEO: ~~ ~~~ I. TANK DESCRIPTION COMPLETE ALL ~TEMS -- SPECifY ~ UNENO~ A, OWNER'S TANK I.D.~ B. MANUFAC~RED BY: C. DATE INSTALLED (MO/DAY'EAR) ~-- ~0 -- ~ ~ D. TANK C~ACI~ IN GALLONS: II. TANK CONTRAS IF A-1 IS MARKED. COMPLETE ITEM C. A. ~ MOTO" VEHICLE FUEL ~ 4 OIL B. C. ~ la REGULARuNLEADED ~ 3 DmESEL ~ 6 AVIATION GAS ~ UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 OTHER (DESCRIBE IN ITEM D. BELOW D. IF IA.l)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC,~DALLTHATAPPLIESINBOXD A. ~PEOF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WITH E~ERIOR LINER ~ 95 UNKNOWN SYSTEM~2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAULTEDTAN~ ~ 99 OTHER B. TANK ~ 1 BARE STEEL ~ 2 STAmNLESS STEEL ~ 3 FIBERGLASS ~ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERI~ ~ 5 CONCRETE ~ 6 POLWINYL CNLORmDE ~ 7 ALUMINUM ~ e lorn/. METHANOL COUPATmBLEW/FRP (PrimaryTank) ~ 9 BRON~ ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 O~ER ~ 1 RUBBER LINED ~ 2 AL~D LINING ~ 3 EPO~ LINING ~ 4 PHENOL~ LINING C, INTERIOR LINING ~ 5 GLASS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 O~ER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES ~ NO~ D. CORROSION ~ 1 POLYETHYLENE WRAP ~ 2 COATING ~ 3 VINYL WR~ ~ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ~ 5 CATHODIC PROTECTION ~ 91 NONE ~ 95 UN~OWN ~ 9g O~ER IV, PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEMTYPE A ~ 1 SUCTION A~ 2 PRESSURE A U 3 GRAVIW A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~ 2 DOUBLE WALL A ~ 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A ~ 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING ~8 10~/~ METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A ~ 99 OTHER D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR ~ 2 LINE TIGHTNESS TESTING ~ 3 tNTERSTITIAL MONEORING ~ 99 OTHER V, TANK LEAK DETECTION ~ t VISUAL CHECK ~ 2 INVENTORY RECONCILIATION ~ 3 VAPOR MONITORING ~ 4 AUTOMATIC TANK GAUGING ~ 6 TANK TESTING ~ 7 INTERSTITIAL MONITORING ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER VI, TANK CLOSURE INFORMATION I 1. EST,MATED DATE LAST USED (MO/DAY. R) 2. ESTIMATED QUANTI~ OFsuBSTANCE REMAINING GALLONS 3. WAS TANK FILLED WITHiNERT MATERIAL ? YES ~ NO~ THIS FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE LD. NUaBER ~S COaPOSEO OF TYE FOU8 N~BERS 8ELOW COUN~ ~ JURISDICTION ~ FACILITY STATE I.D.¢ ~ I I I I PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (g-go) THIS FORM MUST BE AO~MP~IED BY A PERME ~PUOATION · FORM A, UNLESS A OURfiENT FORM A HAS BEEN FILED, !. One FO~M "B" shall bc completed tk)r each tank for all ~'~¥ FE~, ~E~[[* ~.~NG[kS, ~b3OVA]..S ~nd/or any Mark an (X) in the box next to the item flint best descdbes the reason the form is being conlpleled. 2. Indicate the DBA or FadtJly name where the tank [s installed. A. :ndicate o~ne~ tank iD gg - If them is a tank number ~hat ks used by the ~er to identify the tank (ex. AB70789). B. indicate the name of the company ltlat manul~ctumd the tank (ex. ACME TANK MFG.). Indicate lhe year tim tank was installed (ex. 1~7). D. indicate th~ tank c~pacily in gallons (ex. ~,0~ or 10,0~0 1. [f MO'TOR VEHICLE FUEL check box I and complete items B & C. 2. if not MOTOR VEHICLE FUEL, check th~ appmprJat~ box in section A and Check the appropriate box. (! Ch~ck the tyf~ of MOTOR VEHICLE FUEL {Jr box I is checked ~n .?tint ~he chemical n~m~ of 1he hazardous substance stored in Ibc tank and the C,A.S.~. (Chemical Abstract numbcr)~ ~f bo~ 1 is NOT checked in A. 1. Chedc only one [tent in 'tn/PE OF SYSFEM, TANK MATERIAL, IN'II~RIOR I,[NING and CORROSION PRO'~KiFION. 2 ~[ O'I']{ER, print in th~ space provided, 1, Circle P. if abo~ ground; circle U if underground: and circle both if applicable. 2. If UNKNOWN, elrel~; or if OED'tEK print in space provided. 3. Indicate Ibc L~K D[~I~CI'ION s~lem(s) u~d to comply with tho monitoring requirement tbr thc piping. 1. ir~dicate thc LfLeK DETECFION system(s) used to comply with fl~e monitoring requirements for the tank. 1. [k~JFtMATED DKI'E ~' USED - MObZllt~FP~R (January, 1988 or 01./88). 2. F~q'I~MKFED QUANIII~ of I..tA~RDOUS SUBKI'ANCE remaining in the tank (in Gallons). 3. WAS '12NK FILLED WITIt INEKI' MAlt~I~AL? Check 'Yes' or The slate underground storage tank identification number [s composed of the two digit county number, the three d~git ~urisdicfion number, the six digJ~ hcility number and the s~x d~gir tank number, l~e county and jurisdiction numbe~ are predetermined and cnn be obtaMed by call~ng the State Board (916)739-242t. 'Fne f3dlity number must be the same as shown in {btm %% The ~hllk nnnber may bo gssigned by the ioc,d agency; however, this number must be numerical and cannot contain an alphabet. If ~he loc,d agcncf prefers tt~{. Stale Board to assign the t;mk number, please tca~ il blank, STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [~ 1 NEW PERMIT ~ 3 RENEWAL PERMIT .~ 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBA OR FAC~UTY,AME WHERE TANK ~S ~NSTALLED: 7--~'X',=..~ ~ ,~~"~ ~'~<~"" I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# B. MANUFACTURED BY: c. DATE ,NS TALLED(MO,DAY EAR, J"--Z O-- ? D. TANK CAPACITY IN AL O,S: II. TANK CONTRAS ~A-~ is MARKED, COMPLE~ITEM C. ~ 2 PET"OLEUm ~ 80 EMP~ ~1 PRODUCT ~ lbPREMIUM ~ 7 METHANOL UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 L~DED ~ 99 O~ER (DESCRIBE IN I~M D, BELOW II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B. ANDC, ANDALLTHATAPPLIESINBOXD A. TYPEOF ~DOUBLE WALL ~ 3 SINGLE WALL WITH E~ERIOR LINER ~ 95 UNKNOWN SYSTEM ~ 2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAULTED TAN~ ~ 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [~ 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVlNYL CHLORIDE [] 7 ALUMINUM ,,~..8 100% METHANOL COMPATIBLE W/FRP (Primarymank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR ~;~5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YESES. NO__ D. CORROSION [~ I POLYETHYLENE WRAP ~ 2 COATING [] 3 VINYL WRAP ~/..4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [~ 91 NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUNO, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~ 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A(~ 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A IJ 99 OTHER D. LEAK DETECTION ~ ~ AUTOMATIC LINE LEAK DETECTOR [~ 2 LINE TIGHTNESS TESTING ~ INTERSTITIAL MONITORING ['~ 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK .~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING ..~_7 INTERSTITIAL MONITOR,NG [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION I 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OFsuBSTANCE REMAINING GALLONS 3. WAS TANK FILLED WITHiNERT MATERIAL ? YES[] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW COUNTY # JURISDICTION Ct FACILITY # TANK Ct STATE I.D.,/¢ ~ I I lll III I PERMIT NUMBER PERMIT APPROVED BY/DATE I PERMIT EXPiRATiON DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B.R4 2. i?his form should be complcled by ¢kher the PBRE~I' APiP~C~2~F or the ~}C~, AG]?~q{t UND~i~RG~%GUND 3 Plc~sc t?a or prhlt ctcarly alt req~esicd informatiom Usc a ha~d point v~itimg instrument, yea ate making 3 copies. 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or Facility name whom ihe tank is installed. indicate o,~e~ tank ID # - If there is a tank number that is used by the ~ner to identit}, the tank {ex. AB70789). B. Indicate the name of the company that manul~actured the tank (ex. ACME TANK MFG,). C. indicate the year the tank was installed (ex. 1~7), D. Indicate the tank capacity in gallons (ex. Z%000 or 10,O~ etc.). a. 1. ~f MO'FOR VRI~ICLE FUEL, daeck box 1 and complele items B & C, EItlCI.,r, FUEL, check the appropriate box in section A and complete items B & D. 2. if not MOTOR V B. Ci~eck the appropriate box. C. Check the type of MOTOR VE}IiCLE P~EI. (if box 1 is checked in A), Print thc chemical name of the hazardous substance stored in the tank and lhe CA.S.~. (Chemical Abstract Sol.ice number), if box 1 is NOT checked in A. t, Check only one item in ~PE ()P SYSFIi{M, IiANK MATERIAL INTERIOR LINING and CORROSION PROTECI'ION. 2. ~[ OTHER, print ia the space provided. I. Circle A if above ground; circle [l if underground; and circle both if applicable. 2. R' UNXNOWN, cimle; or if OTIIEK print in space pn~vidcd. 3. indicate the LEAK DtrlI'{CIION s}~tem(s) u~d to comply with the monitoring requirement for the piping. 1. ~dicatc fi~c LPsIX D~[!~C'F1ON system(s) used to comply with the monitoring requiremems for the tank. 1, I!~'I'I~TEI) DATE I~ USIM) - MON~-I~FAR (Janua%', 1988 or 01/88). 2. ~'I~MATED QUANI:TI~ of HA~RDOUS SUBglANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED wrDf INERT MA'IT~L? Check 'Yes' or 'NO'. The slate underground storage tank identification number Js composed of the two digit county number, the three digit jurisdiction number, ~lle sN digit facilky number and the s~x digit tank number. '['l~e county and jurisdiction numbe~ are predetermined and cfm be obtained by calling the State Board (916)739-2421. The hdlity number must be the same as sho~ in form "A". iank number may be assigned by ~he k~zal agency; however, thk number must be numerical and cannot contain an alphabet. the locat agc~cy pre[cr~ the Slate }~eard to assign the tank m~mber, please leave ft blank. C/O STATE OF CAUFORNIA ~* * f*'.~"~ STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEr~ MARKONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT ,~5 CHANGE OF INFORMATION r~ 7 PERMANENTLY CLOSED ONSITE ONEITEM [] 2 INTERIM PERMIT ~] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED D.A OR FAO,L,TY .AME WHERE TA.K ,S ,.S'rALLED; >,/',P I. TANK DESCRIPTION COMPLETE ALL ~TEMS -- SPECIFY ~F UNKNOWN o. DAT[ INSTALLED(MO, DAY'EAR) d'--2_o- '~' ~ D. TANK CAPAC,TY ,N GALLONS: /'o 0 c~ 0 II. TANK CONTENTS IF A-1 IS MARKED. COMPLETE ITEM C. A..~1 MOTOR VEHICLE FUEL [] 4 OIL B. C. [] la REGULAR ~3 DIESEL [] 6 AVIATION GAS UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 L~DED ~ 99 O~ER (DESCRIBE IN ITEM D. BELOW D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: IlL TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, AND ALL THAT APPLIES IN BOX D A. TYPE OF .[~.1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [~ 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM .,[~_8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR J~5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES,,,~ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP _~ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A IJ 1 SUCTION A ~___~) 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~ 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND AIj 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A [I 4 FIBERGLASS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING ~ 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A tJ 99 OTHER D. LEAK DETECTION ,,~ AUTOMATIC LINE LEAK DETECTOR [~ 2 LINE TIGHTNESS TESTING ~ INTERSTITIAL MONITORING [--~ 99 OTHER V, TANK LEAK DETECTION [] 1 VISUAL CHECK ~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING ~ 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION [ 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OFsuBSTANCE REMAINING GALLONS [ 3. WAS TANK FILLED WITHiNERT MATERIAL ? YES [---~ NO ~--~ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# ~ I I I PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO341~R4 2. !'his btm should be completed by either thc [F~PAY2~2 ~:PPiJ~C~,b~F or the ~.X~(~ AG[!bJ~.~ UND~J~RGg~C~UND Please t¥? or p~dnt clearly Mt requested inbrmation. 4. Usc a ha~d poinl ~ifing instrument, you are makMg 3 cop/es. [. Mark an (X) ff~ the box next to the item that best describes the reason the lbrm ~s being completed. 2. indicale the DBA or Fadli~y name where the tank ~s installed. A, ~ndicate o~ne~ tank iD ~ - If there is a tank number that is used by the o~mer to identit~ the tank (ex. AB70789). B. indicate thc name of the company that manulhctured the tank (ex. ACME TANK MFG.), C. lndicate the year the tank was installed (ex, lfBT). D, Indicate the tank capacity in gallons (ex, ~,0O0 or 10,~ etc,). 1. if MOTOR VEIiiC[..E I'~EL, check box 1 and complete items B & C. 2. ~f not MOTOR VEItiCLE FUEL, check the appropriate box in section A and complete item~ B & D. Check the appropriate boy C.Check the tyim of MOTOR VEHICLE FUEl, (ff box i is checked in A). D. Print thc chemical name of the hazardous substance stored in the rank and the C.A.S.~. (Chemical Abstract Service number), if box 1 is NGT checked in A. t. Check only one iienl in ~PE OF SY~EM, TANK MAIl,RIAL, IN'II5R1OR I.INING and CORROSION PROTECI'ION. 2. Y.f O'[711{R, print in lhe space p:rov[ded. {iscle A ii above grotmd; ch'cie U if underground; and circle both if applicable. 2. ~f 'GNXtqO%rN~ ciix. lc; or if O~IllE~ print in space provided. 3. h~dicate the LEAK Dt}YI!!CIlON system(s) used to conlply wilh the monitoring requirement Ibr the piping. !. Yndicale the L~K DIJ['ECFION system{s} used to comply wilh the monitoring requirements for the tank. 1. IiSTIMATED DATE LAgI' USED - MON~'II/WPRR Ganua%', 1988 or 01/88). 2. F~I'IMATED QUANIII~ of I. IA~RDOUS SUBS~DSNCE remaMing in the tank (in Gallons)~ 3. WAS TANK FH~LED W1Ttl INERT MAI12IUAL? Check 'Yes' or The sta{e u~dergrou~d storage tank identification ~u~ber ~s composed of the two dig~t cotmly ~umber~ the three digit jurisdiction numbur, thc six digit facility number and the six digi{ tank number. 7lie county a~d jurisdiction numbe~ are predetermined arid can be ebtaJac6 by calling ~hc State Board (916)73%2421. The facility number must be the same as shown in form '?~". ~aM: kt:mbc: may be assigned by the local agency; however, this number must be numerical and cannot contain an alphabet. the it;etd agcn:/ prefe~z the State 5~oard to assign the tank m~mber, please teave it blank, STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [~ 1 NEW PERMIT [] 3 RENEWAL PERMIT ['~ 5 CHANGE OF INFORMATION ~ 7 PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: -7'~,.~..~..~__~ ,.j,,,.',~:~.,~,,,,, ~,~~ I. TANK DESCRIPTION COMPLETE ALL iTEMS -- SPECIFY IF UNKNOWN II. TANK CONTENTS ~F A-1 ~S MARKEO, COMPLETE ~TEM C. A. .~ MOTOR VEHICLE FUEL [] 4 OIL B. C. ~ la REGULAR L~J 3 DIESEL ~ 6 AVIATION GAS UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER (DESCRIBE IN ITEM D. BELOW D. IF iA.l) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S. ~: II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC. ANDALLTHATAPPLIESINBOXD A. TYPEOF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WITH E~ERIOR LINER ~ 95 UNKNOWN SYSTEM ~ SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAULTED TAN~ ~ 99 OTHER B. TANK ~1 BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERGLASS ~ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTI~ MATERIAL ~ 5 CONCRETE ~ 6 POL~INYL CHLORIDE ~ 7 ~UMINUM ~ S lOm/~ METHANOL COMPATIBLEW/FRP (PrimaryTa,k) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER C, INTERIOR ~ 5 GLASS LINING ~6 UNLINED ~ 95 UNKNOWN ~ 99 O~ER LINING IS LINING UATERIAL COUPATIBLE WITH 100% UETHANOL? YES__ NO~ O. CORROSION ~ 1 POLYETHYLENE WRAP ~ 2 COATING ~ 9 VINYL WR~ ~ 4 FiBERGLaS REINFORCED PLASTIO PROTECTION ~ 5 CATHODIC PROTECTION_~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER IV. PIPmNG INFORMATION cm.c~ A mFABOVEGROUNDOR U IF UNDERGROUND. BO~ mFAPPLICABLE A. SYSTEMTYPE A U 1 SUCTION ~2 PRESSURE A U 9 GRAVI~ A U 9g OTHER B. CONSTRUCTmON A~ 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U g5 UNKNOWN ~ U gg OTHER C. MATERIAL AND ~ U I 8ARE STEEL A U 2 STAINLESS STEEL ~ U 3 POLWtNYL CHLORIDE (PVC)A U 4 FIBERGLAS PIPE CORROSION A U 5 ALUUINUM A U 6 CONCRETE A U ? 8TEEL W/ COATING A U B lO~ UE~ANOL COMPATIBLEW/FRP PROTECTmON A~ g GALVANIZED STEEL A U 10 CATHODIC PROTEOTtON A U 95 UNKNOWN A U 9g OTHER D. LEAK DETECTION ~ AUTOUATIC LINE LEAK DETECTOR ~2 LINE TIGHTNESS TESTING ~ 3 iNTERSTITIAL MON~ORING ~ gg OTHER V. TANK LEAK DETECTION ~ 1 V[SUAL CHECK ~2 INVENTORY RECONCmLmATION ~ 3 VAPOR UONmTORING ~ 4 AUTO~ATmCTANK GAUGING ~ 5 GROUNDWATER UONITOR[NG ~6 TANK TESTING ~ 7 IN~RSTITIALMONITORING ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER VI. TANK CLOSURE INFORMATION THIS FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER 18 COMPOSED OFTHE FOUR NUMBERS BELOW COUN~ ~ JURISDICTION ~ FACILITY STATE I.D.~ ~( I I I ( I I Ill I PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FO~U B (~-go) THIS FORM MUgT BE AC~PANIED BY A PER~ff ~PUCATION · FORM A, UNLESg A CURRENT FORM A HAg BEEN FILED. '1. ()ne FO3'3~q "B" shall be completed for each tank for all NL~,¥ ?LL~,t~'IlYg, l?I~]Pd;~/lg]? ~NG~?~q, ~[MOVALS and/or any 3. J;lcasc typ: or print clearly all requesled information. 4, Usc a bard point writing insmmmnL you are making 3 copies~ Mark an (X) in the box next ~o tim item ~hat best describes the reason the form ~s being completed, 2. indicate the DBA or Fadlity name where lhe tank ~s instal[cd, Zndicate mvne~ tank iD ~ - If them is a tank number that is used by the ~'ner to identit}, the rank (ex. AB70789). B. indicate the name of Ihe company that manul~actured the tank (ex. ACME TANK MFG.). C. lndicale the year the lank was installed (ex. 1987). D, Indicam ~he tank capacity in gallons (ex. ~5,~ or 10~OO0 c~c.). A. I. if M()'TGR VS~IIICL!~ FUEL, check box 1 and complete items B & C, ~. ii nm MOTOR VEilICLi5; FUEL, check the appropriate box in section A and complete items B & D. Check lhe appropriate box. Check the isle of MOTOR VEHICLE FUEL (if box 1 is checked in Print the chemical name of the haza'~ous substance stored in the tank and Ihe C,A.S.~. (Chemical Abstract Se.~ice quints:r), if box 1 is NOT checked in A. i. C~eck only one item i~ TYPE OF SYS/EM, [I')SNK MATERIAL, IN'II~fRIOR I,tNING and CORROSION PROTECHON. 2. ~f OTIIER, print in the space provided. Circle A if above gro[md; circle U if underground; and drcle both if applkable. 2.1[ UNXNOWN, cie'lo; or if OTIIEK print in space pmvkled. 3.Indicate lhe LT~SK DE~gCI'ION s)~tem(s) used to comply with the monitoring requirement for the piping. :,~dicatc the L~cxX DrJI'ECI'ION system(s) used to comply with the monitoring requirements R')r tile tank. I. ILSWIMATED DATE LAST USED - MON~t~[f, AR (Januao~, 19~ or 01/88). 2. ESTIMATED OUANI'TI~ of HAZARDOUS SUBSq'ANCE remaining in tile tank (in Gallons). 3. WAS 'lANK FILLED WITH INERT MA~IIi~I,? Checlf 'Yes' or 'NO'. slale unSerground storage tank idemificafion number is composed of the ~wo digit county number, the three digit jurisdiction numbor, the six digit facility number and the six digit tank number. 5[~e county and juhsdiction numbe~ are predetermined and can be obtained by calling the State Board (916)739-242t. The facility number must be the same as sho~ in form "A". tank number may be assigned by the local agency; however, this number must be numerical and cannot contain an alphabet. the local agc:~cy prefe~ the Slate tumrd to a~ign the tank number, please leave il blank. STATE OF CALIFORN)A STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [~ 7 PERMANENTLY CLOSED ON SITEI ONEITEM [] 2 INTERIM PERMIT ~ 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS INSTALLED: '~'~,~C'¢~-.. C 0 ,..r'~"-'~ I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN I II. TANK CONTE~S ~FA-~ IS MARKED. COMPLETEITEM C. ,. ~o~o, w,,~[ ~[~ ~ , o,~ ~. c. ~ '~"[*~*"~ , ~,[~[[ ~ ~ ,v,.~,o,**s ~ 3 CHEMiCAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 L~DED ~ 99 OTHER (DESCRIBE IN I~M D. BELO~ D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. $: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPEOF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM ~ SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER lB. TANK ~ BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING ~ UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO,~-. D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION,~,91 NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION /~ 2 PRESSURE ,~ U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A(~l SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A IJ 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYV~NYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE ,~, U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A~)9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR ~2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONffORING [] 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK ,,~2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUNDWATER MONITORING ~L6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION 4 7 SUBSTA.CE .EMA,.,.G 'LLONS ,.ERT MATE.,AL ? / THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D../¢ ~ II I I tlllll f(llllll PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMrF APPLICATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B-R4 One F.%....M '%" shall be eompleted for ea,::h taM~ for all ~F~Y F~'~V~'R% FE~W ~GFz~, ~dOVA~ ~d/or any Flcase tyia: or print clearly aH requcslcd informatioa~ 4. Usc a t~ard point whfing instrument, you am making 3 copies. I. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. ~ndicate the DBA or Facility name where thc tank is installed. indicate r>a'nem tank ID fJ - If there is a tank number that is used by the owner to identify' thc tank (ex. AB70789). Indicate the name of the company that manuJ~ctured the tank (ex. ACME TANK MFG0. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. ~,000 or 10,080 etc.). A, 1. ff MOTOR VEIilCI.E FUEL, check box 1 and complelc items B & C. 2. if not MOTOR VEHICLE FUEL, check the appropriate box in section A and complele items B & D. B.Check the appropriate box. C.Check me type of MOTOR VI')'JtlCLE FUEl. (if box 1 is checked in 2rint fha chemical name of the hazardous substance stored in the tank and the CA.S.~. (Chemical Abstract So,ice number), if box 1 is NOT checked in A. 1. Check on~y one ilem in ~IWPE OF SYSI'EM, ISXNK MAX'ERIAL IN'D~iI~OR lINING and CORROSION 2. if OTIfER, print in the space provided. !. Circle A if above ground; circle t~ if underground; and circle both if applicant. 2. if ~NXNGVCN', eimle; or if elliS!R, print in space provided. 3. h~dicate the L~dxX D!Yt!{CFION sDtem(s) u~'d to comply wi~h the mo,itoring rcquiremei, t for the piping. I. Zodicatc ~hc Lr~AK DIfNiCF!ON system(s) used to comply with the monitoring requirements for the tank. ]. I~7¢TIIVL,S~YED DA'I!~ LAST USEI) - MONTII~TLAR (lanuao', 1988 or 01/88). 2. F~SI]MATED QUANqlI~f of HAT~RI)OUS SUBSDXNCI% remaining in the tank (in Gallons). 3. V/AS TANK F~'!,LED WITtt INERT MA'IT!RIAI.? Check 'Yes' or 'NO'. The slale underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digi~ facility number and the six digit tank number. {[~e county and jurisdiction numbem are predetermined and can he obtained by calling the State Board (916}739-?A2L ~e facility number must be the same as sho~ in form "A". m:'~ r ;:.55b:~ .uny b~ essigt~cd by Ibc tcsat agency; however, this number must be mmlcrical and cannot contain an alphabet, if' ,i,:. *cea! agc~.cy p~.Acrs ~he Slate i,oard ~o assign the lank noml>er, please leave il blank. STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT [~ 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [~ 7 PERMANENTLY CLOSED ON SITE ONE ITEM [~ 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED DBAOR FACIUTY NAME WHERE TANK IS INSTALLED: 7~ ~("g~L ~--0 I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D., II. TAN K CONTE~S ~F A-1 ~S MARKED, COMPLET~ ~T~M C. UNLEADED UNLEADED ~ ~ JET FUEL ~ 9 CHEUIOALPnODUOT ~ g5 UNKNOWN ~ ~ WASTE ~ ~ L~DED ~ gg O~ER (DEDORIBE mN ~ D. BELOW Da IF (Am ~ )mS NOT MARKED. ENTER NAME OF SUBSTANCE STORED ~,~__~/~ III. TANK CONSTRUCTION UARK ONE ITEM ONLY mN BOXES A, B, AND~,ANDALLTHATAPPLIESINBOXD A. TYPEOF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WITH E~ERIOR LINER ~ 95 UNKNOWN SYSTEM ~2 SINGLE WALL ~ 4 SECONDARY CONTAINUENT (VAULTED TAN~ ~ gg OTHER B. T~K ~l BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERGLASS ~ 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL ~ 5 CONCRETE ~ 6 POLWlNYL CHLORIDE ~ 7 ALUUINUU ~ 8 10~/~ UETHANOL COMPATIBLEW/FRP (PrimaryTank) ~ 9 BRON~ ~ 10 ~LVANIZED STEEL ~ gfi UNKNOWN ~ 99 O~ER ~ 1 RUBBER LINED ~ 2 AL~O LINING ~ 3 EPO~ LINING ~ 4 PHENOL~ LINING C. INTERIOR ~ 5 GLA88 LINING ~6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER LINING IS LINING UATERIAL COMPATIBLE WITH 1~. METHANOL? YES__ N~ D. CORROSION ~ 1 POLYETHYLENE WRAP r-~ 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [~ 91 NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUNO. BOTH IF APPLICABLE A. SYSTEMTYPE A U i SUCTION A~ 2 PRESSURE A U 3 GRAVll¥ A U 99 OTHER B, CONSTRUCTION A(~ 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION ~[~9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR ~ LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING E~ 99 OTHER V. TANK LEAK DETECTION J [] 1 VISUAL CHECK-~2 INVENTORY RECONCILIATION ~--~ 3VAPORMONITORINGr-~ 4 AUTOMATIC TANK GAUGING J-~ 5 GROUND WATER MONITORING iz~.6 TANK TEST,NO [] 7 ,NTERST,T,ALMON,TOR,NG [] 9~ NONE [] 9S UNKNOWN [] ~ OTH~, vi. TANK CLOSURE INFORMATION THIS FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR ~MBERS BELOW COUNTY Ct JURISDICTION Ct FACILITY Ct TANK # STATE I.D.# ~ ( I PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B. R4 !. O~le .e,., ,.:., shall be completed Jbr each tank for ail ~W ~, P~W~T (~fi~G[~Z, ~OVALS and/or any ?lease ty~ o~ print clearly all requested infom~atiom 5. Ugc a hard petal w;iiing instrument, you arc making 3 copies. l.N;ark a~ (X) fi~ tJ~e box next to the Jlem iha~ best descrit.~ca fl~e /easoa the form k beiag completed. indicate the DtLA o~ iPacility name where the tank is installed. :ad,cate c;:ne~ tank ~D ~¢ - If there is a tank ~umber that is used by the owner to identify' the tank (ex, AB70789). B. indicate the name of the company that manuiSqctured lhe tank (ex. ACME TANK MFG.). C. lndicale the year the tank was installed (ex. l}B7). Indicate the tank capacity in gallons (ex. ~,~ or 10,~ etc.). l. ~f M(YYOR VEIilCi.E FUEL, check box 1 and complelc items B & C. 2. I? no'r MOTOR VEilICIZ~ ~:UEL, check the appropriate box in section A and complete ilems B & D. B.Check the approprNte box. C.Check th; fygc or MOTOR Vt);}t[CLE I:'~EI.. (if box 1 is checked in D. 2tint ~he chemical name of thc hazardous substance stored in lhe lank a~d lhe CA,S.~. (Chemical Abstract Service mmfie::), if box 1 is NOT checked in A. C:~eck oi~ty ~:c item in TEmPi'! OF SYSTEM, TANK MATERIAL, 1NDiR1OR I.JNING and CORROSION PROTECI'ION. 2. 7[ f;T!I!D&, print in ~he si>ace provided. CLde A, if abo~v gmar~d; ct:to U if underground:, and circle both if applicable. 2. 5'f UNXNCWN, circle; or if O"ISIEi~ print in space p~vided. 3. bvJicete the LEAK DlSYI:~CFION system(s) u~d to comply wii~ the monitoring rcqoirement for the piping. !, :ndkalc d:c L,:BAX D:I'EC!'ION system(s) used to comply w~tt~ the monitoring requiremeats for the tank. t. ESTIMATED I}ATE LA~' USZ}D - MO~rI'tI/YI~R (Janua~', 1988 or 01/88). ~ST'tMATED QUA?:t:FIW of HAZARDOUS SUBSqS~NCE remaining in tim tank (in Gallons). WAS TANK FH,I,ED WITH INERT MATf~R1AL? Check 'Yes' or 'NO'. The state underground storage tank identification number is core.ned of the two digit county number, the three digit jurisdiction number, the six digit hcility number and the six digit tank humbert :[~e county and jurisdiction numbem am predetermined and can be obtained by calli,g *he State Board (916)739-242l. ~e hcility nmnber must be the same as sho~ in term "A". tanh number may De assigned by the l~al agency; however, Ibis number must be numerical and cannot contain an alphabet. :ha k:-.d agm~c/ prcfcm the Stare Board to assign ti~e tank number, please leave it blank. STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. I MARKONLY [~ 1 NEW PERMIT I--~ 3 RENEWAL PERMIT [--~ 5 CHANGE OF INFORMATION ~,, 7 PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT E~ 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE 8 TANK REMOVED D.A0. FAC,L,TY.AMEW.E.ETA.K,S,.STALLED: I. TANK DESCRIPTION COMPLE~ ALL ITEMS -- SPECIFY IF UNKNO~ I A. OWNER*S TANKI. D., B. MANUFAC~RED BY: II. TANK CONTE~S IF A-1 IS MARKED, COMPLETE ITEM C. A. UNLEADED~ ~ GAS~OL ~ 2 PETROLEUM ~ ~ EMP~ ~1 PROD~T ~ lb PREM~UM ~ 7 METHANOL UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 OTHER (DESCRIBE IN ITEM D. BELOW D. IF IA.l) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC. ANDALLTHATAPPLIESINBOXD A. TYPEOF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM ~2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 9g OTHER B. TANK ~ BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVlNYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] g9 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING .j~.6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ N~ D. CORROSION [] I POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [~91 NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION A(~ 2 PRESSURE ,~, U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A(~ 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U gg OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION .~9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A IJ 99 OTHER D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR I~ 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MoNn'ORING [] 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK ~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUNDWATER MONITORING ~8 TANK TESTING [] 7 INTERSTITIAL MONITORING [] gl NONE [] 95 UNKNOWN [] gg OTHER VI. TANK CLOSURE INFORMATION I 1. ESTIMATED DATE LAST USED (MO/DAY/YR)'"'~ --~' ~[ 2. ESTIMATED QUANTITY OF ~ 3. WAS TANK FILLED WITH YES [] ! THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D../¢ ~ I I I I II I I I I I I 111 [ PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM a (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B-R4 Ylcase typs or print clearly ail requested inforn'tatioa. Use a hard point writing instrument, you are making 3 cop/es. 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. indicale the DBA or Facility name where the tank is installed. A. /indicate o>mem tank ID eft - tf ther~ is a tank number that is used by tl~e ~ner to identity the tank (ex. AB70789). B. indicate the name of the company that manulS~ctured the tank (ex. ACME TANK MFG,). C. }'ndicale the year thc tank was inslalled (ex. I987). Indicate tim tank capacity in galkms (ex. ~,OO0 or 10,(~90 A. I. ~f MCT'OR VEHICLE FUEL, check box ! and comptem items B & C. 2. ~f no~ MOTOR VEiilCLE:. FUEL, check the approprlale box in section A and complete items B & B. Check tt~e appropriate boxo C. C!nc~'< lac typz of NiOTOR V.{!lli'CL!~! FUEl. (ff box 1 is checked in A), 2,'mt la,~ chcmicat name of thc tmzardoos substance stored in ~he *ank and the C.A.S<#. (Chemical Abstract Service r,~,rabe 0, if box ! is NOT checked in A. E;heck only one item in '[%'PE OF SYSI'EM, TANK MATERIAL, tNWERIOR LINING and CORROSION PROTECI'ION. 2. H' OTHER, print in th~ space provided. I. Circle ~qx if above ground; circle U if underground; and circle both if applicable. 2. :~ UN~(NOWN, circle; or ~[ OTIIE1h print ia space provided. 3. indicate the L.%&K DI~fFE(7I'ION s55tem(s) used U) comply wi~h the monitoring requirement for the piping. Ladicatc the LEAK D~I'ECFION system(s) used to comply Mth the monitoring ~equircments for the tank. 1. I'?~TIMATED DATE IAgF USED - MON~t~F~M{ (Januao', 19~ or 01/88). 2. ~WtMATtSD QUANITIW of I~RDOUS SUBg[ANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITII INERT MA'DgRIAL? Check 'Yes' or 'NO'. ::m;e underground storage tani~ identification number }s composed of the two digit county number, the tiwee digit jurisdiction ~'icmbc;. ti'm '~i:~ 2igit f~'cility r, umber and the six digit rank number. 7[1~e county and jurisdiction numbe~ are predetermined and ca,5 be olxai,md by calling gm State Board (916)739-242I. 'Fha facility numher musl be thc same as sho~ in form "A". ~a~k rmmbcr may bc assigned by the Ir>cal agency; however, Ibis number must be mmlcricat and cannot contain an alphabet. If ihe iaca~ agra,tV prefers the State B~ard to assign the tank number, please leave it blank. BAKERSFIELD FIRE DEPARTMENT December 5, 1996 .~ CHeEr Texaco Refining and Marketing MICHAEL R. KELLY 1900 E. Los Angeles Avenue, Suite 200 Simi Valley, Ca 93065 ADMINIS19,ATIVE SERVICES 2101 'H' Street Bokersflelcl, CA 93301 (805) 326-3941 R.~: Underground Storage Tanks located at Texaco Star Mart #0988, 3621 FAX (O0~) 395-1349 California Avenue, in Bakersfield California. SUPPRESSION SERVICES 2101 'H' Street Dear Texaco Refining and Marketing: Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 A~ I am sure you are aware, all existing single walled steel tanks that do not meet the current code requirements must be removed, replaced or upgraded to PREVENTION SERVICES 1715 Chester Ave. meet the code by December 22, 1998. Your tanks do not currently meet the new Bakersfield, CA 93301 code requirements and therefore fall into the remove, replace or upgrade category. (805) 326-3951 FAX (805)326-0576 Your current operating permit expires on or before that date and of course will not be renewed until appropriate upgrade of your tank system is accomplished. ENVIRONMENTAL SERVICES 17 t5 Chester Ave. Bakersfield, CA 93301 In order to assist you and this office in meeting this fast approaching (805) 326-3979 FAX (80,'5) 32643576 deadline, I have attached a brief questionnaire addressing your plans to upgrade these tanks. Please complete this questionnaire and return it to this office by mining DIVISION Friday, December 20, 1996. 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 If yOU have any questions concerning your tanks or if we can be of any FAX (805) 399-5763 assistance, please do not hesitate to contact this office. Sincerely, Hazardous Materials Coordinator Office of Environmental Services REI-I/dlm attachment CITY of BAKERSFIELD FIRE DEPARTMENT 1715 CHESTER AVENUE M. R. KELLY BAKERSFIELD, 93301 F~RE CHIEF October 20, 1994 326-39. TEXACO STAR MART L~ iJ' TEXACO MARKETING & REFINING P O BX 7812, 4TH FLOOR UNIVERSAL CITY, CA 91608 Dear Business Owner: This notice serves as a reminder that owners of underground storage tanks must be registered with the State of California Water Resources Control Board and renew that registration every five years. Our records indicate five years have passed since your last State registration pursuant to Section 25287 of the California Health and Safety Code. This means that for state registration renewal you must submit an Underground Storage Tank renewal application form, Forms A. B and C completed for each tank at this facility (forms included) and a state surcharge of $56.00 for each tank. Please make your check payable to the City of Bakersfield. You have 30 days from the date of this letter to complete and return these forms along with the state surcharge to 1715 Chester Ave., Bakersfield, Ca. 93301. If you have any questions or if we can be of any further assistance please don't hesitate to call 326-3979. Sincerely Yours, Ralph E. Huey Hazardous Materials Coordinator REH/ed ANNUAL INVENTORY RECONCILIATION Facility: 7~Xe~to 4'7~,-a~'/a/,7" FA"O~; .4~ Tank # Size Product Address: Permit/ID I hereby certify under penalty of perjury that: All inventory variations for this facility were within allowable limits for this year. Inventory variation(s) exceeded the allowable limits during this year. The source of the variation(s) is not due to an unreported, unauthorized release. List the Month, tank number, and amount of variation for all variations which exceeded the allowable limits during this year. MONTH TANK # AMOUNT OF VARIATION/EXPLANATION 5 · Additional incidents shall be listed on a separate, attached sheet of paper. If the cause of the variation(s) which exceeded alloWable limits was a leak, the incident(s) shall be reported no later than the next business day to your local permit implementing agency. An Unauthorized Release Report shall be submitted within five days. The Annual Summary Report shall be submitted within 15 days of the end o~ each year. TANK ~~ D~TE / · ~ 61J-OSE*~2203Q 362~ CALIFORNIA~FffENUE · AKERSFIELD, CA 9~304 s-az rev. (CA) ~ 8-91 ..... .... ' INVENTORY RECONCILIATION/MONTHLY MONITORING OF. UNDERGROUND TANKS MONTH/YEAR ~o~_ ~ ~ ADDRESS: 3 7 3 ~ 3 { G> 3 ' 3 8 77 8 <~7 8 · (Z~ 8 ~/( 8 10 10 <~ 10 <D3% 10 . L 10 12 (//7 12 6~7 12 {Ua7 12 y ~ 12 ~3 ~ ,, .~3 ~3 ~ z3 ~ ~3 .. 14 <~o7 14 14 < ~ 14 ~ 14 ,15 ~ 15 15 Y~ 15 ~.~ 15 2o <~> 2o 2o ~z~ 2o ~ 2o 2[ {~.~ 2[ 2[ ~ g~ 2[ ~ ,~ 2[ 22 {J~7 22 22 y /3'~ 22 ~ 22 23- ..3~ ' 23 23 -31 -- 23 ~ 23 .- 24 <~;~ 24 24 ~Qg~ 24 <l> 24 ., 25. ~/ 25 $ 25 O~ 25 C 2S ' 26 ~/~7 26 26 ~g~ 26 ~ 26 1% OF DELIV~IE8: 1% + 130 G~LONS = YES (~ IF YES - STATE ~CTION T~KgN C~ O~R ~LO~LE ? ?..?~OTIFIED: ~ O O ~ I CERTIFY THE ABOVE IS ACCURATE AND TRUE. MANAGER/RETAILER DATE S-SH rev. (CA) 8--91 ...... INVENTORY RECONCILI~TION/MONTELY MONITORING O__F UNDERGROITND _TANK~ ' . 6'1-058-022030 (0988) MONTE/YEAR ~- ?7 ADDRESS: 3621 CALIFORNIA AVENUI BAKERSFIELD, CA 93304 TANK 1 TANK 2 TANK 3 TANK 4 TANK'5 1DAY ~1~+/-~ 1DAY ~'+/-7 1DAY ~J~+/' 1DAY +~7~ 1DAY ~+/- ~3' /~ ~3 ~ ~3 :~-. ~3 ~ ~3,.. 14 ~1.7>'.. 14" <'~'% 14 ~,~1> - 14 . ~ 14 .~s (/~Z ,. , 16 ~o 16 ~ ~ ~ _ 16 ~ 16 20 / i 20 / ~ 20 20 20 2x ~ ,~ 21 ~ 2x 2x 2x 24 ~ ~ 24' ~ 2~ 25. (/~ . 25" ~e~ 25 25 27 27 27 ~ 27 27 27 2s ~19~ 2s ~> ,, 28 . ~ 28 ~o 28 29 29 29 29 29 30 30 30 30 30 3f 31 31 31 31 T~ DELIVERIES: /7dE? 17 .5 / 7o S5 1% OF DELIVERIES: 1% + 130 G~LONS = THE ABOVE IS ACCURATE AND TRUE. ....~ OF UNDERGROUND TA~ 61.058.022030~ (0988) MONTH/YEAR '~. 5Yz// ADDRESS: 362'1 CALIFORNIA AVENUE ~AK~.~SFiF. Lo, CA 9~304 TANK I TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY": +/- DAY +/- DAY +/- DAY +/- 2 (~_) 2 ~'A~ 2 2 ~ 2 3 ~ %q~ 3 ~ ~ ~ 3 (2~ 3 / 3 8 ~3 8 /,~- 8 ~q 8 ~g& .8 11 ' -y/ 11 f3 11 ~ ~2 11 11 12 (3~7 12 (a.~. 12 ~ ~ 12 ~v) 12 13 q9 13 ,~ 13 ~,~' 13 ~'~ 13 14 ~3 14 / ~ 14(~ 14 ~q 14 17 (~'5) 17 <3/3 17 (I 3~3 17 ~33V 17 20 '~, 20 I 20 ' .I 20 ~ t~ 20 21 (. ~ ~ 21 ( 3~ 21 ( 3 o7 21~/ 21 22 C/-7 22 ~ 22 (~F 22 22 23 (/y~ 23~ 23 . 23 ~/ 23 24 .(g3) 24 ~/~ 24 . (22~ 24 ~, 24 25 r~p 25 ',q-' 25 '''~:l' 25 {~ 25 26 (/77 26 (3~ 26 ( ~7 26 26 27 /~' 27 '/0 27 27 > 27 28 (//) 28 4~9 28 43q> 28 ( ~) 28 29 3 ~ 29 ~ 29 ~ ~ 29 4t. 29 cm cm lq cm lq cra, u¢ cm TOTAL DELIVERIES: 1% OF DELIVERI~: 1/2 OF 1%: 1% + 130 GALLONS = CUM OVER ALLOWABLE: ? Y~ ~ IF Y~, STATE ACTION TAKEN AND WltOM NOTIFIED: CERTIFY THE ABovE I A MANAGER/R~FAILER DATE ......... . .... ·-.INV~R¥ RF_.~-ONCILIA?'I~ION/MO~ MONI,TQRING ' ~ '":~"' "~" ....... ~ OF'UNDERGROUND TANnll~'u°~'uzzu-~o - (0988) 3621 CALIFORNIA AVENUE MONTH/YEAR <~7o~/ ~ y ADDRESS: BAKERSIFll=I D, o.a_.. 93~,r~ . · TANK I TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY-~ +/- DAY +/- DAY +/- DAY +/- 1 .-/3a 1 (.,2 7 1 ~..f'o: 1 .( 7 7 2 ,,./7 2 ,...c 2 ., ,, 2 "(',;~7 2 6 4.2 a'7 6 q' 3.7 · 6 6 6 7 _~dy7 7 457 7 7 ' 7 8 -t 6~-- 8 . ~ ,,e/ 8 v-.ga 8 8 9 09;7 9 ~ 9 ~,~,~.7 9 ,,o'~ 9 10 /8' 10~/3 I0 10 ...:5. 10 11 ~/&5 11 < a~> 11~'/~)5'"7 11" ,, ~. 11 12 .fao? 12 4'.~ ~7 12 12(~V 13~3 13 &' 13 ' '7q' 13 13 14 <~/6,> 14 <J E5 14 <. ¥5 14 ;2 14 16 16. / '~ 16 _.._-- 16' .3 16 17 .(/oo ~ 17 3 ~ 17 F_a,&-"'~ 17' -q / 17 18 3~7 18 ~.,9.~ "~ 18' ----- 18 19 ¢ ?.,'//7 19 ~/~-- 19 . L,, ~ ,~, 19 .- 19 ~E2~ ~'/9'7 21~ 21 /--5 (3 /;2/ 21~ 21 "23 k. ' 23 ~,3/e' 23 23 ,, .. .24 24 ~6c-~ ~6 ~ 26 c~,~ ~6~<~7 26 27 ~ 27 ~ 27 '~ 7 27~ 27 29 q ~ 7 29~~ 29 ( 3 ~ 29'~ 29 30 (/aT 30 q ~ 30 ~c~ 30 30 31 ' 31 31 31 ' 31 CUM '~ qq¢ C~ ? 37 CUM 4 7/g CUM + 3ff CUM TOTAL DELIVERIES: 1% OF DELIVERIES: 1/2 OF 1%: 1% + 130 GALLONS = CUM OVER ALLOWABLE: o YES ~ IF YES, STATE ACTION TAKEN AND CERTIFY THE ABovE IS TE I MANAGER/RETAILER DATE - 61-058-022030 (0988) '::'.,":5'": ':.:- '?'~ '~ ~,..~'.?:~E~RY,: RE~ONCILIA'IION/MO~ MONITOr.CALIFORNiA AVEJ O1. UNDERGRO~ TAI~Ig '- BAKJERSFIELD, CA 933( MONTH/YEAR /'2~,,4/¢ - TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY~ +/- DAY +/- DAY +/- DAY +/- , 7 , / 2(/g> 24.5) 2 '7 2 ~ 2 3 <'.~v>" 3 '5~.>_." 3 ,4/4> 3 /.:r-' 3 4 '~",,7. / 7 4x,.~/ .... 4 ~ ~(,'7 4 4o" 4 5 .~'-/ 5 (/,,'7 5 t//- 5 ? 5 6 '6a0.2". 6 ¢.~ ~ 6 4..7a'7 6 -,,/3 6 8 8. 9 9' (o2-5 9 9 9 ~0 10 ~ ~ 10 10 / 10 11 ( 13D 11 (2-'~ 11 4,_/&) 11 , ~' 11 12 '~/77 12 ( .2 7 12 4' .g / 7 12 9' 12 13 -,,4. q'o 13 -'t 3.q'- 13--/$"7'--/$" 13 ~ ~r 13 14 ~'/7 2 14 ('~]. ? 14 ( ~ &--'7 14 ~'.2, 14 15 ..,, ~.~-' 15 v'/-g 15~ 15 -t'/~ 15 ~7" <1~> 17 ' / ~7 60,t3 17 -o ~7 18 ~o 18 /.3 18 'ZS- . ,, 18 -O 18 22 22 22 (,~ I? 22" 22 23 oqo 23 23 'i 24 24 24 ____(L~._. 24 ( '" 24 ' 25 (/¢ 5 25 ~ 25 ~)3> 25 5 25 26 ,~'8 26 ~3o 26 7o 26 (q ~ 26 27~/~ > 27 < 7x 27 ~N 27 < 75 27 28 ~¢ 28 / 7 '" 28 ~ 28 (,g) 28 29 ,~ } 29 ~ 29 (~,5 ) 29 q ~ ~ ) 29 30 ~;~7~ 30 ~:,> 30 d~e3, 30 f/~> 30 CUM ~¢ CUM IbC CUM qg~ CUM /g~ CUM TOTAL DELIVERI~: 1% OF DELIVERI~: I I I. I I 1/2 OF 1%: 1% + 130 GALLONS = CUM OVER ALLOWABLE: ? Y~ NO IF Y~, STATE ACTION TAKEN AND WHOM NOTIFIED: /V~ 61.-058-022030 (098 :.,~:.-p:.~.',.~ :'...:. :.-?: '.-:INV~ORY, RECONCILIATION/MON~ MONITORII~2! 'CALIFORNIA AY .... ~ OF ~ERGROUND TAI~lg ' BAKERSFIELD, CA 93 / TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY''~ +/- DAY +/- DAY +/- DAY +/- 5 % 5 < 5 ¥~s-> 5 5 7 ~.~ '> 7 dq '2 7 ¥ 7 7 8 (q ~ 8 ¥ ~' > 8 /-a 5'> ' 8 ~3_~ .8 11 11 (]?~ 11 ~,'7~ 11 ~ 11 12 (/~, 12 ~ 12 /~ / 12 ~ q ) 12 14~ 14~ 14 (3~ ~ 14 ~ 14 15 {Q~ y 15 15 ~a*7 15 w~ 15 16 /0~. 16. (37 16 /~ 16 ~ 16 17 /a(/a ~ 17 4 6/ 17 ~ 7/ 17 ~ 6 17 19 19 19 ~3V~ 19 19 2o 2o 2o {¢~5 2o G 2o 21 2~ (3~ 2~ ~ 21 ~ 2~ 22 22 ~ ~ 22 ~ ~ 22 ~ 22 23 23 s 23 ~ 23 / 23 25 4 7~ 25 (a 25 ' 25 {/ 25 26 27 ~-~/~-5 27 ~7~ 27 (~7~ 27 'o 27 28~ 2s ~e~ 28- 4/a~ 2~~ 2~ 29 ~ 29 ~-~~-- 29 ~ (,Ts5 29 · 29 30 /q 7 30 (, 5 30 ~ 30 30 31 31 31 31 31 CUM 357'CUM ~33 CUM eli CUM ¢~--CUM TOTAL DELIVERI~: ~ OF DELIVERIE: 1/2 OF 1%: 1% + 130 9ALLONS = cvu OVeR A~OWAgeE: 2 .V~ ~ ~e V~, STATg ACTION TAee~ ANU ~ /' ~ ~ ti . ceuv v v.e A OW '- 4 -30 - DATE ,.,., ,.-- ~ .... :, ,-.-INV~RY,:~ONCILIATION/MONTI-I~ MONI~.I~U2~0.~0 (0988) "": ~ :' ' ..... ~ 'OF UNDERGROUND 3621 CALIFORNIA AVENUE MONTH/YEAR t.Z~'Z/ ADDRESS: RAKERgFI£LI~.. CA 93304. TANK I TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY~ +/- DAY +/- DAY +/- DAY +/- 2 .-//5} 2 -t6,2 2 ~ 02 o"' q 2 <'//7. 2 3 (,2.27 3 ~ 3 <' 4, S'"'~ 3 ~/a '7. 3 4 Co~.~} 4 ('55 4 C37} 4 ~ .'3¥ . 4 5 <.;3q 5 5 ~3~ 5 //~r 5 c'~ 5 5 6 ./or~ 6 ,[, .q}..- 6 (5~o') 6 iq % 6 8 4./~, 7' 8 .( v 7 8 ($..c7 8 + 6-- ·8 9 '(1~'7 9 -/73 9 d~t79 9 -/ ~ 9 ~0 4~ ~0 ¥~.5 10 <z/~> ~0 -3 ~0 12 q~ . ~2 cst> ~2 /~, 12 ,;~ ~2 13 (/73 13 ' Z7 13 ~7 13 ~ 13 14 (',ao 7' 14 ,;3 ... 14 f'~ 7? 14 009.. 14 16 o-- 16 16 (.e. o7 16 ';toZ 16 17 /5/ _ 17 .... 5/0 17 '7~ 17 ~ 17 18 dq> 18 ' (5-5 18 ('5'.~ '~ 18 15g 18 19'~? 7 19 (q7 19 ('~a7 19 5"' 19 20 e ? 20'~;& 20~,,o,g 20 ,3 20 21 ~ ! o ) .. 21 < 35 21 < .'3 5'5 21 /t, 21 22 -/. ?~, 22 <77 22 ,,/~, r,, 22-r. 22 23 ' ( ? ? 23(,s-'7 23 -(,~o'2 23 ,~, ~ 23 24 d/e? · 24 ..... (.~) 24(/3~7~ 24 O- 24 - , 27 {/~'5 27 27 (2 z~ 27 ~ 27 28 d'o 28 ( ~, ~ 28 /¥ / 28 '7 28 29 4 / 7~7 29 4 --t '7 29 <' ,3 / ~ 29 -o--- 29 30 a, ~' 30 ' ' { ~- ? 30 la / ' 30 .a- 30 31 <'-53 31 <%¥ 31 .(iq} 31 (I> 31 CUM ~9/O CUM %~/ CUM I Oo~\ CUM 17,/ CUM TOTAL DELIVERIES: 1% OF DELIVERIES: ~5~-I ~oa..I ~% I -77 I 1/2 OF 1%: 1% + 130 GALLONS = 33~ g~-3 20'7 CUM OVER ALLOWABLE:. ? ~)_.NO .,IF Y--E,S, STATE ACTION TAKEN AND WItOM NOTIFIED: '{"'/e" ~ ~,'~'"'F , ,' - // '/;~ c, ,',-,-,. - I/ ~ OFUNDERGROUNDTAI~fS ~-058-022030 (0988) MONTH/YEAR ~ ~97 ADDRESS: 362] CALIFORNIA AVENUE ~' BRKiiRSFIELI:h CA 93~4 TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DA~~ +/- DAY +/- DAY +/- DAY +/- 3 3 3 3 4 4 ~ 5 4 ~g~¢ 4 ' 4 s ~x, -7 5 (z 2 5 ~ 7 5 ~ 2 5 ,.- tO, ~5 zo(,t5 t0 ~v-~ ~o ~ ~o 11 f~3 11" q~ 11 /o~ ' 11 11 12 . q 7~ 12 (? ¢ 12 z/, 2 ~ 12 ~/$ 12 13 (/a ? 13 (~ ? 13 {a~7 13' e/7 13 ~4" (275 ~4 ' ~- ~4 /oq ' ~4~ ~4 15 ~g3~ ]5 ' 'L~ 5 ~5 < ~b 15 ~ ~5 ]6 g& ]6.dq) . ]6 /&~ 16 ~ 17 d333 17 d&5" 17 dt~5 17 y 17 18 (~37 18 <5-) 18 Cqg) 18 7 18 19 ' ~/3~ 19 (/07 19 ~ 9~ 19 ~/ 19 2~ 2~ 2~ ~ 2~ ~. 22 ' =- 22 ~O 22 / .'~ q 22 ~ 22 23 d/G$ ' 23 O> 23 (~¢5 23 q 23 25 '(1'0'5 ' 25 dC) 25 (go~ 25 .... o 25 26 (a ~ 26 4 2 ~ 26 /o 7 26 ~ > 26 27 ~ ~tOo~ 27 (~3~3 27 ~/.~/at~ 27 (2'~/37 27 29~/> 7 29 ¢39 29 '¢/3 ~ 29'(¢~ 29 30 (/~ 7 30 ~. 30 ~ 7 30 (2~ 30 31 Q75 31 (~ 31 <~ 31d&~' 31 CU'M ~5~' CUM qiC CUM )iS3 CUM ]~Z CUM TOTAL DELIVERIES: ~ OF DELIVERI~: 1/2 OF 1%: //s I J ssc J J J 1% + 130 GALLONS = --~;~ WltOM NOTIFIED: CERTIFY ~ ~ATE~U~:~ , ~.,' ,': ,.. '. :INVF-~I~R¥'. RF_~ONC. Ii,IA'DION/MO~ ' .... " ": ': :"~ OF UNDERGROUND TAblI~ $~2! CALIFORNIA MONTH/YEAR ,ff'~/o ADDRESS: I~AKERSFIELD, c:al 93304 TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 .DAY +/- DAY'~ +/- DAY, +/- DAY +/- DAY +/- 1 /o~ 1 ,~.ff } 1 ~? I ~ $~ 1 "4xd/9 4 <.~v 2 4 (.,z $ 2 4 ~ q o 4 8 4 8 , :>.'47 8 ./~/ 8 10 10 ~9_ 10 -t ?a~? 10 & 7 10 11 x//~,> 11 (_~5 11 ('~5 11' · 7 11 ~2 //~o 12 ( ,~>. ~2 /3-~ 12 ~ 12 16 ~ ~/ 16 ~n'7 16 e~ / 16 ' e/ 16 18/0 18(.q) 18 <~o7 18 t ,9. ~ ,9 ~3. ,9 /_~o 19' ~ 20 < ~" 20 (3_~ 20" ~1% 20' 20 22 ~z5 22 22' ce.~> 22 .... rv~ 22 24 .</,7. 24 ,~7 24 (2.~7 24 "~ 24 25 ' 25~5;" 25~ 25 -- 25 7~x '/3 ' 26 ~ g r 26 (,~> 26 ff//? 26 ~ 26 28 ~~' 28 28 28 28 '3o '" 30 ~ 7 30 ~ ~> 30 "<'~ ~ 30 3I 3I 31 31 3I CUM ~ $ t CUM /3 / CUM /a2q Cm /~ ~ CUM TOTAL DELIVERI~: 1% OF DELIVERI~: " I I I I I I 1/2 OF 1%: 1% + 130 GALLONS = . .', , ..~ -.~.~;. . .... .~.~ ,'~ I q I I I WltOM NOTIFIED: I CERTIFY THE~BOVE IS A~~R~~ DATE ~...: ::. :..:': ,. :..-.INVF_,N,T~RY RECONCILIATION/MON~ MONITO~C:jS~022030 (0988) TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DA~~' +/- DAY +/- DAY +/- DAY +/- 1 (1~ 1 ~ ~ 1 ~ //o 1 (~ ~ 1 2 (~ 2 2 d ~ 2 ~' 2 3 3 3 3 3 6 /~o' ~ 6 ( ~2' 6 .~ 6 ~ 6 7 ~//7 7 (,~ ~ 7 (/~ 7 ~ 7 10 10 ~ 10 e~&) 10 ~/,. 10 11 //~ 11 11 ' ~ 11 ~ 11 13 13 ( ~ 13 (~ 2 7 13 ~ 13 15 (i1} 15 ( 3} 15 d 17) 15 ~,~ 15 16 ~/~5 16, ~ 16 d?9~ 16 ~4> 16 17 ~ ~ ~ 17 17 ~ ~ 17 2 ~ 17 18 d i, 18 (~7 18 (/~ 18 ~ 18 19 { ~¢ 19. ~7 19 (2~ 19 19 20 ~ ~> 20 &q 20 /q/ 20 ~//>' 20 2~ //7 2~ ~ / 2~ ( ~ 7 2~ '(.~5 21 23 23 23 / 3 23 gT/ 23 24 .~q) 24 ~_~> 24 d~) 24 ~7 24 25 ~7 25 '~ 25 <1,'~ 25 /~ 25 26 26 26 ~ g ~ 26 V/~ 26 27 //~ 7 27 (~ ~ 27 ~ 27 ~ 27 28 ~/,~ 7 28 d~ ~ 28 (' 7 28 ~ 28 29 v ~ 29 '~ q 7 29 ~3 ¢ 29 r ~ 29 30 ~ 30 &~ 30 30 30 / 30 31 < ~ 31 4~> 31 75 31 ~ 31 cu~ /5/ c~ )~ cu~T] cm/~ cm TOTAL DELIVERIES: 1% OF DELIVERIES: 1/2 OF 1%: 1% + 130. GALLONS = I I · I CUM OVER ALLOWAnLE: ? ~~ NO ~F Y~, STATE ACTION TAKEN AND >~AN~GER/RE~I~ILER DATE 3621 CALIFO!'!r~A AVENUE MONTH/YEAR /6,06; ADDRESS: BP. KERSF!ELD, CA 93304 TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY'~ +/- DAY +/- DAY +/- DAY +/- 2 <"7~ 2 4~> 2 'd/?) 2 ,~ 2~ 2 4 </7) 4 4/5 4(')75 4 ~ 4 5 3;z 5 (~> 5 .qT, 5 (,,> 5 8 '~7 8 ~ 8 '~ 8~3~ 8 13 ¢.&5' 13 ,~,,~5 13 ~7' 13 ,~} 13 14' ( &> 14 /~ 14 '~ 14 /.~ 14 16" ~7 16, ~ 16 (~27 16 ¢g 16 17 (/g7 17 . (~y 17 ~ I7 3 17 18 (~/7 18 '~ 18 (2a~ 18 ~3 18 21 21 21 21 ~ 21 22 ~ 22 ~ 7 22 22 22 23 ~ ~ 7 23 .(, ~ 23 ~9/ 23(~ 23 24 ' . ~ 24 ~ 7b' 24(~ 24~ 24 25 25 ~ g ~ 25 ~ ~ 25 '~ 25 26 ' ¥//~ 3~ 26 ~7 ~ 26 (~ 26 yg ~ 26 27 ~l'l~ 27 ~Z~ 27 (9~ 27 ~V~ 27 28 ~0/ 28 ~ 28 ?~ 28 ~'/~ 28 29 q 29 29 29 29 30' 4~,~ 30 ~/0 30 30 ' 30 31 ~ ' - ' 31 ~ - 31 -- 31 / 31 cm cm cm/ cm /g¢ TOTAL DELIVERIES: 1% OF DELIVERI~: I/2 OF 1%: 1% + 130 GALLONS = CUM OVER ALLOWABLE: ? Y~ ~0~ IF Y~, STATE ACTION TAKEN AND WltOM NOTIFIED: IS A AT U CERTIFY THE ABOVE,' ' ,//-~-0-7¢/ MANA 'FAILER DATE '""~ .... ~ OF UNDERGROUND T~~~,' .... ,,,",'"~., , ,.. [. ' ' MONTH/YEAR Xg&"~ 97 ADDRESS:. BAKER$FIE-Lo, ~A 93304, TANK 1 TANK 2 TANK 3 TANK 4 TANK 5 DAY +/- DAY'~ +/- DAY +/- DAY +/- DAY +/- 2 3 7 7 3 (.'/2 3 3 ~/7 3 9 9 9 ~7 9~ 9 11 11 12 12 ,,~ ,. 13 q 13 ¢ 13 .... ~3 13 / 13 16 ~¢7 16 ~37 16 4/~ 16O~ 16 20 20 .~ 20 20 20 22 22 ~ b 22 22 22 23 23 23 ' 23 23 24 ,7. " 24 ' 24 ~ 24 .... e ~ 24 27 . ~ 27 q 27 ~/c 27 27 28 3o 28 q I 28 ~ 28 28 CUM Cm CUM g Cm cm TOTAL DELIVERIES: 1% OF DELIVERI~: 1/2 OF 1%: 1% + 130 GALLONS = CUM OVER ALLOWABLE: ~ Y~ ~ IF Y~, STATE ACTION TAKEN A~ WItOM NOTIFIED: I CERTIFY THE ABOVE IS ACCURATE AND TRUE: /o2-,r/ . IV-IANAGER/RETAILER DATE CERTIFICATION OF FINANCIA FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM ~. X am required to demonstrate Financial RespoMiba;ty in the required mounts as specified in ~cfion 280% Chapter 18, Div. :3. Tide 23, CCR: ~ 500,000 dollars per occurrence ~-~ l milton dollars annual afsresate o~ AND or ~'~ 1 minion dollars per occurrence ' ' ~-~ 2 minion dollars annual a~regate [3. ~FD(ACO R~FINING AND AA^RK~iNG INC. . t~.~eby ce~ifies t/Mt/~/s/n comp/i~Aae wi~h the ~equ/mmenf~ Article 3, Chapter 18, Division 3, 7'#le 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: Self- TEXACO INC. Insurance 2000 Westchester Ave. P.lhite Plains, N.Y. 10650 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of th~ cer'Jfication also certifies that you are in compliance with all conditions for participation in the Fund. 1) "Texaco fJ058-1405 Bakersfield, 93301 2) . ~.' Texaco Star Mart ~058-1408 r~~hite Lane & Potrero z Bakersfield, 93304 3) /~'~'~Texaco Star Mart ~058-0988 ~~California & Real Bakersfield, 93309 4> ~'~'~Texaco ~,~058-0700 3698 Ming & R~09 ! Bakersfield, 5) '~"~"=' ,,Texaco gtar Mart f~058-0799 ~5~=Gosford & White Lane · ~_ Bakersfield, 93309 \ cr~) Texaco f~058-0450 ~u~o~=a-~=~ °~-~21 Stockdale & New Stein ) Bakersf±eld, 93309 "WE CARE" [: January 30, 1995 FIRE DEPARTMENT 1715 CHESTER AVENUE M. R. KELLY WARNING ! 8*,ERSF, ' 9=0, FIRE CHIEF 326-3911 CERTIFICATION OF FINANCIAL RESPONSIBILITY REQUIRED 215-.000-000330 .7~.1 C~c~r-oe~A ,~,~ TEXACO STAR MART ? 0 BOX 7812, MARKETING i.]NIVERSAL CITY, CA 'B1~08 Dear Underground Storage Tank Owner: Our records indicate that your business does nee have a Certification of Financial Responsibility on file with this office, Please forward either a copy of your existing State approved mechanism to show financial responsibility or else complete the attached Certification of Financial Responsibility form. An attached letter from the State Water Resources Control Board lists the approved financial responsibility mechanisms required to pay for corrective actions resulting from leaking underground fuel tanks. Remember, most tank owners only have to show financial responsibility for at least $10,000 of clean up liability. The Underground Storage Tank Clean Up Fund (USTCF) may be used as the mechanism to cover the remaining accidental release liability. The total amounts of financial responsibility required (check boxes from section A of form) are as follows: If you don't sell product from you tanks, and you pump less than 10,000 gallons per month, check "$500,000 per occurrence". Else, or if you are in the business of selling from your tanks, check "1 million dollars per occurrence". For owners of 101 or more petroleum underground storage tanks, check the "2 million dollar annual aggregate" box. All others need only check the "1 million dollars annual aggregate' box. Please be aware that failure to provide the financial responsibility document to this office within 30 days will result in your Permit to Operate being revoked. (25285.1 (b) California Health & Safety Code). ~ If you have any questions, or would like help in completing the Certification of Financial Responsibility, please contact Howard Wines, Hazardous Materials Technician, at 326-3979. Sincerely, Hazardous Materials Coordinator REH/dlm e erate Underground Hazardous Materials Storage Facility HAZARDOUS aATER~ALS O~WS~ON 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 (805) 326-3979 Approved by: Ralph E. Huey, Hazardous Materials Coordinator Valid from: · Complete items 1, 2, and 3. Also ~c,~ mplet~. item 4 if Restricted Delivery is des[fed. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 'addressdEl'erentfromlteml? [] Yes 1. Article Addressed to: If YES, enter delivery address below: [] NO Texaco Star Mart '? I 3621 California Avenue o.x.~rv~co~ ( Bakersfield, CA 93309 .~ Ceffifled Mall I'1 Express Mall [] Registered l'3 Return Receipt for Merch~ndlse [] Insured Mall [] C.O.D. . 4. Restricted Delive~t? (Extra Fee) [] Yes 2. Article Number I ~ . (rta~fer~omsen~cetat~0 7Drl3 ;=PhD DDD~t 7hSP 3:lhi~ PS Form 381 1, August 2001 Domestic Retum ReCeipt 102595-02-M-1541;- · Sender: Please print your name, address, and ZIP+4 in this box ° Bakersfield Fire Department Prever~ert ~Vices 1715 Chesl~r,~; Suite 300 B~i~l~l,, ~,~, ~'~'301 ~- Postage I $ ._-I- Certified Fee Postmark ~--1 Retum Reclept Fee I (Endorsement Required) I Here r--~ Restricted Del~y~mLEe~_[ ,=D (Endorsement ~' I'U Total Posta~ Texaco Star Mart mm, [sontro 3621 California Avenue ~'~'~-~:x Baker · " ~- [ or ~,o Box ~,sfield, CA 93309 Certified I~l Provides: m A mailing~lll~pt (eeJe,~el~) ~00~ eunr '008S uJJo.4 Sci la A unique identifier f~. your. rn~plece · ' A record of delivery kept by the Postal Service for two years Important Reminders: · Certified Mall may ONLY be combined with First-Class Maile or Prio~ty Mail~ · Certified Mail Is not available for any class of IntemaUonai mall. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mall. For valuables, please consider Insured or Registered Mail. · ' For an additional fee, a Return Recelptmay be reque.sted to provide p_mof of delivery. To obtain Return Receipt servlce,.ptease complete and attach a Hetum Receipt (PS Form 3811) to the article ano add applicable postage to cover the fee.. Endorse mailpieee "Return Receipt Requested". To receive a fee waiver for a euplic.ate return receipt, a USPSe postmark on your c;ertified Mail receipt is requlrea. "' For an additional fee, delivery, may be restricted to the addressee or add. mssee's .author{zed a.~nt. Acl~..se the clerk or marl( the mailplece with the enaorsemem "~estn'cteo uellverjr. · If.a postmark o.n t.h.e Ce. rtified Mail receipt is desired, please pre_sent the arti- cle at the post onice for postmarking. If a postmark on the uertified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. nternet access to delivery information is not available on mail addressed to APOs and FPOs. December 12, 2003 CERTIFIED MAIL Texaco Star Mart 3621 California Avenue Bakersfield, CA 93309 RE: Propane Exchange Program FIRE CHIEF RON FR.,,ZE Dear OwnedOperator: ADMINISTRATIVE SERVICES 21Ol "H' S~,eel The purpose of this letter is to advise you of current code requirements for Bakersfield. CA 93301 propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not VOICE (661) 326-3941 FAX (661) 395-1349 apply to large propane tanks, only propane exchange systems. SUPPRESSION SERVICES 2101 "H" Street Over the past two years this office has noted a dramatic increase in the propane Bakerstield, CA93301 exchange system in the city of Bakersfield. It has also been noted, with great VOICE (661) 326-3941 FAX(661)395-1349 concern, that many of these installations are a clear violation of the UFC (Uniform Fire Code) and represent a danger to public health and safety. PREVENTION SERVICES FIRE SAFETY SERVICES * ENYIRONMENTAt. SERVICES 1715 ChesterAve. Accordingly, procedures for storage of propane cylinders awaiting use, resale or Bakersfield, CA 93301 VOICE (661)326-3979 exchange, have been adopted through BMC (Bakersfield Municipal Code) and FAX (661) 326-0576 adoption of thc 2001 UFC. The procedures are as follows: PUBLIC EDUCATION 1715 ChesterAve. Storage outside of building for propane cylinders (1,000 pounds Bakersfield, CA 93301 VOICE (661) 326-3696 or less) awaiting use, re-sale, or part of a cylinder exchange point FAX (661) 326-0576 shall be located at least 10 feet from any doorways or openings in FIRE INVESTIGATION a building frequented by the public, or property line that can be 1715 CheslerAve. built upon, and 20 feet from any automotive service station fuel Bakersfield, CA 93301 VOICE (661)326-3951 dispenser. (Note distance from doorways increases when FAX (661)326-0576 cylinders are over 1,000 pounds cumulatively.) TRAINING DIVISION 5642 VictorAve. Cylinders in storage shall be located in a manner which Bakersfield, CA 93308 VOICE (661)399-4697 minimizes exposure to excessive temperature rise, physical FAX (661) 399-5763 damage or tampering (Section 8212, California Fire Code, 2001 Edition). When exposed to probable vehicular damage due to proximity to alleys, driveways or parking areas, protective crash posts will be required as follows (Section 8001.11.3 and 8210, California Fire Code, 2001 Edition): 1) Constructed of steel, not less than 4 inches in diameter, and concrete filled. 2) Spaced not more than 4 feet between posts, on center. Letter t~o: Owner/Operators of Propane Exchange Sy~ns Re: Propane Exchange Program Dated: December 12, 2003 Page 2 of 2 3) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. 4) Set with the top of the posts not less than 3 feet aboveground. 5) Located not less than 5 feet from the cylinder storage area. Exceptions: Cylinders storage areas located on a sidewalk which is elevated not less than 6 inches above the alley, driveway or parking area, with not less than 10 feet of separation between the curb and the cylinder storage area. "No Smoking" signs shall be posted and clearly visible (Section 8208, California Fire Code, 2001 Edition). Resale and exchange facilities must be under permit to verify compliance. All existing facilities will be checked and when compliance is confirmed, a permit will be issued. All new propane exchange systems must be permitted prior to installation. You will have 90 days (March 4, 2004) to comply with the procedures outlined. Once compliance has been confirmed, each exchange system will be issued a permit, which will be placed on the exchange system. Sites not conforming to current code, will be "red tagged" and must be taken out of service immediately. You should contact your Blue Rhino representative, Mr. Taylor Noland, or your local Amerigas representative. They are aware of current code requirements. If you do not have a propane exchange system, please disregard this letter. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincerely, / Steve Underwood Fire Inspector/Petroleum/ Environmental Code Enforcement Officer January 22, 2003 TeXaco Star Mart FIRE CHIEF ,~ON F~Z~ 3621 California Ave Bakersfield CA 93309 AOMINISTRATIVE SERVICES 2101 UH' Street Bakersfield, CA 93301 RE: Upgrade Certificate & Fill Tags VOICE (661) 326-3941 FAX (661) 395-1349 Dear Owner/Operator: SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 Effective January 1, 2003 Assembly Bill 2481 went into effect. This VOICE (661) 326-3~)41 Bill deletes the requirement for an upgrade certificate of compliance FAX (661) 395-1349 (the blue sticker in your window) and the blue fill tag on your fill. PREVENTION SERVICES FIRE SAFETY SERVICES · EN1/IRONMENTAL SERVICES 1715 ChostorAve. You may, if you wish, have them posted or remove them. Fuel Bakorsflold, CA 93301 vendors have been notified of this change and will not deny fuel VOICE (061) 326-3979 FAX (661) 326-0576 delivery for missing tags or certificates. PUBLIC EDUCATION 1715 ChesterAv~. t' Should you have any questions, please feel free to call me at 661- Bakersfield, C^ 9.3,301 326-3190. VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION . Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-4697 FAX (661) 399-5763 Office of Environmental Services SBU/dc July 30, 2002 Texaco Star Mart 3621 California Ave Bakersfield CA 93309 REMINDER NOTICE F~RE CHIEF RE: Necessary Secondary Containment Testing Requirements by December RON FRAZE 31, 2002 of Underground Storage Tank (s) Located at ADMINISTRATIVE SERVICES the Above Stated Address. 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear Tank Owner / Operator: F^x (664) 395-4349 If you are receiving this letter, you have no.t...yet completed the necessary SUPPRESSION SERVICES 2101 "H' Street secondary containment testing required for all secondary containment Bakersfield, CA 93301 components for your underground storage tank (s). VOICE (661) 326-3941 FAX (661) 395-1349 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California PREVENTION SERVICES Health & Safety Code) of the new law mandates testing of secondary FIRE SAFETY SERVICES · ENVIRONMENTAL SER~ICES 1715 ChesterAve. containment components upon installation and periodically thereafter, to insure Bakersfield, CA 93301 that the systems are capable of containing releases from the primary VOICE (661) 326-3979 FAX (661)326-0576 containment until they are detected and removed. PUBLIC EDUCATION Of great concern is the current failure rate of these systems that have been 1715 Chester Ave. Bakersfield, CA 93301 tested to date. Currently the average failure rate is 84%. These have been due VOICE (661)326-3696 to the penetration boots leaking in the turbine sump area. FAX (661) 326-0576 FIRE INVESTIGATION For the last four months, this office has continued to send you monthly 1715 Chester Ave. reminders of this necessary testing. This is a very specialized test and very few Bakersfield, CA 93301 VOICE (661) 326-3951 contractors are licensed to perform this test. Contractors conducting this test FAX (661) 326-0576 are scheduling approximately 6-7 weeks out. TRAINING DIVISION The purpose of this letter is to advise you that under code, failure to perform 5642 Victor Ave. Bakersfield, CA 9.3.308 this test, by the necessary deadline, December 31, 2002, will result in the vOICE (661) 399-4697 revocation of your permit to operate. FAX (661) 399-5763 This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel frae to call me at (661) 326-3190. Sincerel, Steve Underwood Fire Inspector Environmental Code Enforcement Officer May 29, 2002 Texaco Star Mart 3621 California Avenue Bakersfield, CA,93309 RE: Necessary Secondary Containment Testing Requirement by December 3 l, 2002 of Underground Storage Tank located at 3621 California Avenue FIRE CHIEF REMINDER NOTICE RON FRAZE Dear Tank Owner/Operator: ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 The purpose of this letter is to inform you about the new provisions in California VOICE (661) 326-3941 FAX (661) 395-1349 Law requiring periodic testing of the secondary containment of underground storage tank systems. SUPPRESSION SERVICES 2101 'H" Street Senate Bill 989 became effective January 1, 2002. section 25284. I (California Bakersfield, CA 93301 VOICE (661) 326-3941 Health & Safety Code) of the new law mandates testing of secondary containment FAX (661) 395-1349 components upon installation and periodically thereafter, to ensure that the systems PREVENTION SERVICES are capable of containing releases from the primary containment until they arc' 1715 Chester Ave. detected and removed. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (681) 326-0576 Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. ENVIRONMENTAL SERVICES Secondary containment systems installed prior to January 1,2001 shall be tested by 1715 Chester Ave. Bakersfield, CA 93301 January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component VOICE (661) 326-3979 that is "double-wall" in your tank system must be tested. FAX (661) 326-0576 TRAINING DIVISION Secondary containment testing shall require a permit issued thru this office, and 5642 Victor Ave. shall be performed by either a licensed tank tester or licensed tank installer. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures D April 17, 2002 Texaco Star Mart 362 t California Ave FIRE CHIEF Bakersfield CA 93309 RON FRAZE ADMINISTRATIVE SERVICES RE: Necessary Secondary Containment Testing Required by December 31, 2002 2101 'H" Street Bakersfield, CA 93301 VOICE (661)326-3941 REMINDER NOTICE FAX (661) 395-1349 SUPPRESSION SERVICES Dear Tank Owner/Operator: 2101 "H" Street Bakersfield. CA 93301 Thc purpose of this letter is to inform you about thc new provisions in California law VOICE (661) 326-3941 FAX (661) 395-1349 requiring periodic testing of thc secondary containment of underground storage tank systems. PREVENTION SERVICES 1715 Chester Ave. Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & Bakersfield, CA 93301 VOICE (661) 326-3951 Safety Code) of the new law mandates testing of secondary containment components FAX (661) 326-0576 upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield. CA 93301 Secondary containment systems installed on or after January 1, 2001 shall be tested upon VOICE (661) 326-3979 installation, six months after installation, and every 36 months thereafter. Secondary FAX (661) 326-0576 containment systems installed prior to January l, 2001 shall be tested by January l, 2003 and every 36 months thereafter. TRAINING OIVlSION 5642 Victor Ave. Bakersfield, CA 93308 Secondary containment testing shall require a permit issued thru this office, and shall be VOICE (661) 399-4697 performed by either a licensed tank tester or licensed tank installer. FAX (661) 399°5763 Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at 661-326-3190., Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures ° Sen~der: Please print your name, address, and ZIP+4 in this box ° BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICE6~ ~ 7'~ 5 Chester Avenue, Suite 300 Bakersfield, CA 93301 II,h,,,Ih,,Ihlh,,,,,Ihhh,,hh,,llih,,,,,Ihhl,ll,,,I items 1,2, and 3. Also complete A. Received by (P/ease Print Clear/y) if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. C.~ure°~--~' · · Attach this card to the back of the mailpiece, X~~--~ ~_~ Agent or on the front if space permits. --~,,.j _ _ ___~ AddresseE: D. Is delivery address different from item 17 [] Yes 1. Article Addressed to: If YES, enter delivery address below: [] No Frank Hutchins Texaco Star Mart 3621 Cali2~ornia Ave Bakersfield Ca 93309 3. ServiceType ~ Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article ,b[u~. ~, .~(Copj~,~om service label) 0021 9610 929 . PS I-~,j~ ~'l~l; 5u1~¥99 Domestic Return Receipt 102595-99-M-1789 Postage .$ · 3 2 10 Certified Fee postmark Return Receipt Fee 1 o 5 0 Here (Endorsement Required) Restricted Delivery Fee (F. ndorsement Required) Reciplenrs Name (~lease Print Clearly)'(To be completed by mailer) Yrank [-[ut:ch±ns gFr~T~k~:'/~:;';~'F6"~;' ~g' .............................................. Te×aco Star Mart 3621 Cal±J~or~±a AYe ........... Certified Mail Provides: [] A mailing receipt [] A unique identifier for your mailpiece la A signature upon delivery la A record of delivery kept by the Postal Service for two years Important Reminders: Ia Certified Mail may ONLY be combined with First-Class Mail or Priority Mail, la Certified Mail is not available for any class of international mail. la NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. · For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested", To receive a fee waiver for a duplicate return receipt, a USPS postmark on your Certified Mail receipt is required. [] For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Deliver~'.'. ~ _ ~, · If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is_Qieeded, detach and affix label with postage and mail. IMPORTA ,N~lte this receipt and present it when making an inquiry. PS Form 3800, February 2000 (Reverse) 102595-00-M-1489 August 27, 2001 Frank Hutchins Texaco Star Mart CERTIFIED MAIL 3621 California Ave Bakersfield Ca 93309 ~.~ C.~EF NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RON FRAZE RE: Failure to Submit/Perform Annual Maintenance on Leak Detection ADMINISTRATIVE SERVICES System 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Mr. Hutchins: SUPPRESSION SERVICES OU/' records indicate that your annual maintenance certification on your leak 2101 "H" Street detection system is past due. March 7, 2001 Bakersfield, CA 93301 ' VOICE (661) 326-3941 FAX (661) 395-1349 You are currently in violation of Section 2641 (J) of the California Code of PREVENTION SERVICF..~ Regulations. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 "Equipment and devices used to monitor underground storage tanks shall be FAX (661) 326-0576 installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per ENVIRONMENTAL SERVICES lZ15 chester Ave. calendar year for operability and rtmning condition." Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 YOU are hereby notified that you have thirty (30) days, September 26, 200 I, to either perform or submit your annual certification to this office. Failure to comply TRAINING DtVlSION will result in revocation of your permit to operate your underground storage 5642 Victor Ave. Bakersfield, CA 93308 system. VOICE (661) 399-4697 FAX (661) 399-5763 Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walt Pon', Assistant City Attorney 1715 stet Ave., Bakersfield, CA 933 ., (661)326-3979 .. ~ UNDERGROUND STOOGE TANKS - UST FACILI~ ~PE OF ACTION "- (Check one ~tem only) ~ ~' NEW SITE PERMIT ~. RENEWAL PERMIT ~ 5. CHANCE OF INFOR~TION (S~eci~ change. ~ 7. PER~NENTLY CLOSED SITS ~ 4. AMENDED PERMIT ~cal use only). ~ 8. TANK REMOVEO 4~. 8~SI~-CSS ~ME (~m~a~FACILI~ ~ME. D~- ~ng Busln"s ~ 3 FACIU~ lO, ~ ~ ~ , NEARESTC~QSSSTREET~ /~ 401. FACILI~ O~ER ~PE~ ~ 4. LOCAL AGENCY/DISTRIC~ ~~ ~ ~~ ~ ~(~ ~ ~ ~. co~t~o. D ~. COU~.C~- BUSINESS ~ ~. ~S STATtON ~ ~. FARM ~ 5. COMMERCIAL ~ 2. INDIVIDUAL ~ 6. STATE AGENCY' ~PE ~ 3. PARTNERSHIP ~ 7. FEDE~LAGENCY' ~2. ~ 2. DISTRIBUTOR ~ 4. PROCESSOR ~ 6. OTHER 403. TOTAL NUMBER OF TANKS ~ Is ~aality ~ Indian R~all~ ~ ~ 'If ~ ~ UST a public ag~: name o~ suDe~s~ of RE~INING AT SITE ~ tmstlan~? ~ diesis, s~ ~ ~ ~i~ ~t~ the UST. (~is is the ~ta~ p~ ~ the ~nk I1. PROPER~ OWNER INFORMATION PROPER~O~ER~ME 407. ~ PHONE ~ILING OR STRE~ ADDRESS PROPER~ O~ER~PE ~ 2. INDN1DUAL ~ 4. LO~LAGENCY/DISTRICT ~ 6. STATE AGENCY 413. ~1. COR~TION ~ 3. PAR~ERSHIP ~ 5. ~U~AGENCY ~ 7. FEDE~LAGENCY IlL TANK OWNEE I~F0~A~ION TANK O~ER ~ 414. PHONE 415. CI~ 417. STATE 418. ~ ZIPCODE 41g. TANK O~ER ~PE ~ 2. IND~IDUAL ~ 4. LO~LAGENCY/DIS~ICT ~ 6. STA~ AGENCY 4~. ~ 1. CO~O~TION ~ 3. P~TNERSHIP ~ 5. COU~ AGENCY ~ 7. FED~LAGENCY ~, BOARD OF EQUALI~TION UST STOOGE FEE ACCOUNT NUMBER V. PETROLEU~ UST FINANC~L RESPONSlBILi~ NOtaTE MEMO,S) ~ 1. SE~dNSURED ~ 4. SUR~ BOND ~ 7. STATE FUND ~ 10. LOlL ~ MECHANISM ~ 2. GUA~EE ~ 5. LE~ER OF CRED~ ~ 8. STATE FUND & CFO LE~ER ~ ~. OTHER:. ~ 3. INSU~NCE ~ 6. EXE~TION ~ 9. STATE FUND & CD 4~. VI, LEGAL NOTIFICATION AND MAILING ADDRESS ;h~ ~e b~ to indl~te ~i~ addr~s sh~td be us~ ~ l~al nol~ll~s and mailing. ~ 1. FACILI~ ~ 2. PROPER~ O~ER 3. TANK O~ER 4~. eg~ nobilities and mailings ~II be sent to ~e ~nk ~ unl~ ~ 1 ~ 2 is ~. VII, APPUCANT SIGNATURE ;~lfi~tt~: I ~ ~al the Inf~all~ pro~d~ h~dn Is tree and a~mte to Ihe b~l of my kn~ge. ~AME' 0F'A~PLICAN¢ (p4n0 426. T~LE OF APPLICANT 4~. UST FACILI~ NUMBER (~r~cd use one] 428. I ~ UPG~OE CENTIFIcArE NUMSfiR (Formal use on/y) 4~. I S:~CU PAFORMS~swrcb-a.~d CITY OF BAKERSFIELD OFF OF ENVIRONMENTAL SE /ICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ~PE OF ACTION ~ 1. NEW SITE PERMIT ~ 4. AMENOED PERMIT ~ 5. CHANGE OF INFOR~TION) ~ 6. TEMPO~RY S~TE CLOSURE (Check one dcm only) ~ 7. PER~NENTLY CLOSED.ON SITE ~. RENEWAL PERMIT (Spec~ ma~n . fo~ local use only) (Spec~ change · for local use only) ~ 8. TANK RE~VED 430 ....... , , ~-'-~-~ " LOCATION WITHIN SITE [Op~naO 43 I, TANK DESCRIPTION TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes 434 compa~me~L DATE INSTALLED (YEAR/MO) 435 TANK caPaCITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437' ADDITIONAL DESCRIPTION (For local use only) 438 II. TANK CONTENTS TANK USE 439 ~1a PETROLEUM TYPE 440 1. MOTOR VEHICLE FUEL . REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (Ifmanted. complete Petroleum Ty~e) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIAT1ON FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazam~us Materials Inventory page) 441 i CAS # (flora Hazardous Materials Inventory page) 442 [] 4. HAZARDOUS WASTE (includes , Ill. TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) ]~07.. DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERiAL-pdmarytank [] 1. BARE STEEL ,,,~3. FIBERGLASS/PLASTIC [] 5. CONCRETE E~95. UNKNOWN 444 Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRPCOMPATIBLEW/100%METHANOL []99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL - seco~dar~ tank [] 1. BARE STEEL ~,~3. FIBERGLASS / PLASTIC [] $. FRP COMPATTBLE W/100% METHANOL [] 95: UNKNOWN (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORROOIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10, COATED STEEL [] 5. CONCRETE TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING ~9fl. UNKNOWN 446 DATE INSTALLED 447 OR COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] 6. UNLINED [] 99. OTHER __ JCheck one item only) (For local use only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC ~3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER (Check one item only) [] 2. SACRIFICIAL ANODE (For local uae only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE {For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 l~ 3. STRIKER PLATE L~i.~'~"T' IF SINGLE WALL TANK (Chack elI that epply): 453 IF DOUBLE WALL TANK OR TANK W1TH BLADDER (Check one itern only): 454 [] t WSUAL (EXPOSED PORTION ONLY) [] 5, MANUAL TANK GAUGING (MTG) [] 1. VISUAL (SINGLE WALL tN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 6. VADOSE ZONE ~ 2, CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOU~ ATG [] 7. GROUNDWATER [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 8, TANK TESTING BIENNIAL TANK TESTING ~ 99. OTHER ~- V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE . ¥1MATED DATE LAST USED (YR/MO/DAY) 455 EST_IMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 S:tCUPAFORMS\SWRCB-B.WPD ~;:' ' CITY OF BAKERSFIELD f OFFICE OF ENVIRONMENTAL SERVICES ~ " ,, ;hester Ave,, Bakersfield, CA 93301 (661) 326-3~ UST. TANK ..... ~: ........ Page __~ Gl '~_~ , VI. PIPING CONSTRUCTION (Check ~ that apply) ! ABOVEGROUND PIPING UNDERGROUND PIPING ~. ................. SYSTEM TYPE I. PRESSURE [] .2. SU~CTi.O.N. . [] 3. GRaviTy 458 ..................... i[] 1. PRESSURE i-~ 2. SUCTION [] 3, GRAVITY 459 CONSTRUCTIONJ [] I, SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 I [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER;~2. DOUBLE WALL [] 95. UNKNOWN ![] 2. DOUBLE WALL [] 99. OTHER ' MANUFACTURER 461 : MANUFACTURER 463 :1"~ 1. BARE STEEL [] 6. FRP COMPATIBLE WI100% METHANOL [] I. BARESTEEL ........ ~]- 6. FRP COMPATIBLE W/100% METHANOL MATERIALS AND i[~] 2. STAINLESS STEEL [] 7. C_~LVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL CORROSION PROTECTION i[] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER ;'~4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION i~] 5. STEEL WI COATING [] 9. CATHODIC PROTECTION 464 [] 5. STEELWI COATING [] 95. UNKNOWN 465 "" ' ' VII; PIPING ~EAK DETECTION (Ct~ck all ~hat apply) UNDERGROUND PIPING' ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 46~' PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK. SYSTEM FAILURE. AND.SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3, ANNUAL INTEGRITY TEST (0.1 GPH) [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0,1 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH} SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PiPiNG): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9. BIENNIAL INTEGRrrY TEST (0.1 GPH) [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) I ' 10. CONTINUOUS TURBINE SUMP SENSOR WITFJ. AUDIBLE AND VISUAL ALARMS AND (chec~ one) Ji AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF ~' 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH} SUCTION/GRAVITY SYSTEM: SUCTION/GRAvITY SYSTEM: [] 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) ~ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF · AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS ?] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR [], 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRiCTiON ~ [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL iNTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK : '~,~ ,,~ ,,,~.~;~ r~..* :~ ,,~,~'~,,~. ~, ,~ ,VIII~DISPENSER CONTAINMENT , DISPENSER CONTAINMENT ~ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ~ 4. DAILY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE I ce¢'[i~/~hal the information proviCed herein ts true and ~ccurate ID the best of my knowledge. NAME OF OWNERIOPERATOR (print) ~ 471 j TITLE OF OWNERIOPERATOR ~ 472 / ~JPCF (7/99) S:\CUPAFORMS~SWRCB-B.WPD CITY OF BAKERSFIELD, ,, OF E OF ENVIRONMENTAL SI FVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 · '""--"~"~' '"-' UNDERGROUND STORAGE TANKS - TANK PAGE 1 FYPE OF ACTION [] I. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 6. TEMPOP-ARY SITE CLOSURE (Chock one ,tern only) ~3 [] 7. PERMANENTLY CLOSED'ON SITE · RENEWAL PERMIT (Spec/fy ma.son./or local usa only) (Spectly cflange./or local use only) [] 8. TANK REMOVED 430 ....... ~.~__. ;.. LOCATION WITHIN SITE (OpEonel) 431 I. TANK DESCRIPTION -- Z '?~NK ID # 432 i TANK MANUFACTURER 433 ; COMPARTMENTALIZED TANK [] Yes No 434 · '~'~- i'~-~'~"L-E'~Y~) 435 i TANK CAPACITY }N GALLONS 436 ~ NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIPTION {For local use only) 438 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 1. MOTOR VEHICLE FUEL [] ia. REGULAR UNLEADED [] 2. LEADED [] 5, JET FUEL (If markeq, complete Pet/oleum Type) ~lb. PREMIUM UNLEADED [] 3, DIESEL [-"] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc, MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT [ [] 4. HAZARDOUS WASTE (lnclu~te$ t COMMON NAME (from Hazardous Materials Inventory page) 441!i CAS # (from Hazardous Matetfal$ Inventory page) 442 [] 95. UNKNOWN J · . . III. TAN~ cONsTRuC'rlON TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ~Check one item only) ~2. DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL - primary tank [] 1. BARE STEEL ,~ 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNCWN 4~4 'Check one item only) [] 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGI..ASS ~ 8. FRPCOMPATtBLEW/100%METHANOL []99. OTHER REINFORCED PLASTIC (FRP) rANK MATERIAL - secondary tank [] 1. BARE STEEL ~3. FIBERGLASS / PLASTIC [] 8. FRP COMPATIBLE W/100% METHANOL [] 95. UNKNOWN 4-45 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FPP NON-CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10, COATED STEEL [] 5. CONCRETE rANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LfNING [] 5. GLASS LINING J~95. UNKNOWN 446 DATE INSTALLED 4.47 ]R COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] 'Check one item only) (For local use only) 3THER CORROSION [] 1. MANUFACTURED CATHODIC ~;~ 3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 OATE INSTALLED 449 =ROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER 'Check one item only) [] 2. SACRIFICIAL ANODE (For local use only) ~PILL AND OVERFILL YE. AR INSTALLED 450 TYPE (Forlocal use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 ~ % STRIKER PLATE L~. ~--~;'~r' ~-'~-~ ~., '" '-~:;:":':~ 2 ~ '~ .. ;"~, ~ '. ...... ;,4'.; :-.:,?: .;,,~.~.r~,~¢;;.~,, :~i~ ,;, ~,~! ~;~ '¥' ...... "~'.' .~' ' ............... '.- :, ",~: ' ,?., ~: ~i.,, · ~ "~ :, .;¢ .. ' 4 .; : ~=.~.~; .~: ' :.'J.'~' .:.7~E: '.~¥.~,~:~!:,' '. IF SINGLE WALL TANK (Check alI theI epply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check ono item only): 454 [] 1. VISUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (M'TG) [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 6. VADOSE ZONE ~ 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] 7. GROUNDWATER ! [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 8. TANK TESTING BIENNIAL TANK TESTING [] 90, OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE. ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 PCF (7/99} S:\CUPAFORMS\SWRCB-B .WPD CITY OF BAKERSFIELD /"' OFFICE OF ENVIRONMENTAL SERVICES · ' $ Chester Ave., Bakersfield, CA 93301 (661) ~... UST. TANK PA~,~; · , Vi. PIPING cONSTRUCTION (Check a# that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSfEM TYPE 1. PRESSURE r-'] :~. SUCTION [] 3. GRAVITY 458 [] i. PRESSURE [~ 2. SUCTION [] 3. GRAVITY CONSTRUCTION/ [-'~, 1. SINGLE WALL ~] 3, LINED TRENCH [] 99. OTHER 460 [] 1, SINGLE WALL [] 95, UNKNOWN ' ' 462 MANUFACTURER;{~2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER ......... ' .~. ? .u. F_,.C.?U.R~.__.. ................. ?6_L.~' ............ ~ .~ U_.~*_?_U__~_E~ .......................................... ~63 :~"1 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL {~ l. BARESTEEL [] 6, FRPCOMPATISLEWIIOO%METHANOL MATER;ALS AND ![~ 2. STAINLESS STEEL [] 7, GALVANIZED STEEL , [~ 2. STAINLESS STEEL [] 7, GALVANIZED STEEL CORROSION PROTECTION ; [] 3. PIJ~STIC COMPATIBLE WiTH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE {HOPE) [] 99. OTHER .~4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER i [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION !~"] 5. STEEL Wt COATING [] 9. C,~ATHODIC PROTECTION 464 [] 5, STEEL W/ CGATING ~'] 95. UNKNOWN 465 :' -' ' ' VII, PIPING LEAK DETECTION (C~ck all that apply) UNDERGROUND PIPING' A6OVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all t/laf apply); PRESSURIZED PIPING (Check ali that apply): [] I. ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC L~NE LEAK DETECTOR 3,0 GPH TEST W1T.H AUTO PUMP SHUT OFF FOR LEAK. LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION ~' AUDIBLE AND VISUAL ! / [~ SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) ' 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: t CONVENTIONAL SUCTION SYSTEMS (Check all ~hal apply): [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM ~- TRIENNIAL PIPING INTEG~TY I-'] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST iD. 1 GPH) [] 6, TRIENNIAL INTEGRIT~ TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PiPiNG): ' SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all thai apply): [] g. BIENNIAL INTEGRITY TEST (0,1 GPH) [] 8, DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONT~NED PiPiNG PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBtNE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (ched(one) v;' AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS · AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF ~ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) W]T,H., FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CON'F1NUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14, CONTINUOUS SUMP SENSOR.WITHOUT AUTO PUMP SHUT OFF ,,. AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) W1THO ,UT FLOW SHUT OFF OR I-"~, 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST(O. 1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. OAILYVISUAL CHECK [] 17, DAILYVlSUAL CHECK ;: ,:'..:.~ei¢:~:;;,~.~:~:~: ~;~!~..::~i~;!.~~i.~::~.:~'ii;~biSPENSER CONTAINMENT.*... · ~.. :.:.: .,. . ~..,. : ~ ... ... '~ · ,~i.:":¥:':~. ..... · ." ' ii *'"'.'""'~:'~' '''~. DISPENSER CONTAINMENT '~[ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 4. DALLY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING ~ 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER ~- AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE I ce~l. i.fy t.h_al Ihe infom'~aflOn provil~ed her~n Is t~e an~accurale ID Iha besl of my knowledge. _ ................................. Permit Num~,~ (For ~cal use only) 473 I Permll A,oprc~ved (For local use only) 474 Permit Expiration Dale (For local use only) '415 JPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPD ,,,,;,'~1~ ,,,~...~, _ CITY OF BAKERSFIELD t 2_ ~ ~ b,, q--~ ,.i.~~ OFI~ OF ENVIRONMENTAL S~ICES ~n~r 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 '?'--~ '~' UNDERGROUND STOOGE TANKS - TANK PAGE 1 ~PE OF ACTION ~ I. NEW SITE PERMIT ~ 4. AMENDED PERMit ~ 5. CHANGE OF INFOR~TION) ~ 8. TEMPO~RY SITE CLOSURE (Check only) ~ 7. PER~NENTLY CLOSED ON SITE ~3. RENEWAL PERMIT (Spec~ ma~n - for local u~e only) (SOem~ change - for ~cal u~e only) ~ 8. TANK RE~VED 430 ... ~...~2... :_ ~.. · LO~ON W~HIN SITE (Op~nal) 431 I. TANK DESCRIPTION T,'.NK ,o # ,,32 ', T~.K ~NUF~CruRE. ~3 ! COMPARTMENTALIZE~ TAN,, DATE INSTALLED (Y~) 435 ~ T~APAC~ IN ~LLONS 436 T NUMBER OF COMPARTME~S 437 ADOITIO~L OESCRI~ION (For ~ca/ use only) 438 I1. TANK CONTENTS (~ TANK USE 439 PETROLEUM TYPE 440 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL If marked, complete Pet~leum Type) [] lb. PREMIUM UNLE~DED [] 3. DIESEL [] 6. AVIATtON FUEL [] 2. NON-FUEL PETROLEUM ~ lc. MID(SPADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT ' COMMON NAME (from Hazardous Materials Inventory page) 441 i CAS # (from Hazardous Mate~al$ Inventory page) 442 [] 4. HAZARDOUS WASTE (Includes [] 95. UNKNOWN .. III. TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 EXTERIOR MEMBRANE LINER i--195. UNKNOWN ~Check one Rem only) ~. DOUBLE WALL [] 4. SINGLE WALL IN ^ VAULT [] 9~. OTHER rANK MATERIAL - pdmar~ tank [] 1. BARE STEEL .~3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/100% METHANOL [] 99. OTHER REINFORCED PLASTIC (FRP) FANK MATERIAL-secondar,/tank [] 1. BARE STEEL ~3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEW/100% METHANOL r'~ 95. UNKNOWN 4-45 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FPP NON-CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE rANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING ,~95. UNKNOWN 446 DATE INSTALLED 447 ~R COATING [] 2. ALKYD LINING [] 4. PHENOLIC UNING I~ 6. UNLINED. [] 99. OTHER 'Check one item only) (For local use on/y) 3THER CORROSION [] 1. MANUFACTURED CATHODIC ~3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 DATE INSTALLED 4.49 3ROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER 'Check one item only) [] 2. SACRIFICIAL ANODE {For local uso only) ~PfLL AND OVERFILL YEAR INSTALLED 450 TYPE (Forlocal use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 'C~e~ke,,,he,~,,,y) ~,. SP,LLOONTA',MENT I--~'- ~----'~,~ [] ,. ^LARM __ ~3. F,LL~BESHU'~OF~VALVE__ ~ ~. STR,KER PLATE ~,~'C~'~ IF SING LE WALL TANK (Check sll that apply): 453 IF DOUBLE WALL TANK OR TANK WlTH BLADDER (Check one item only): 454 [] 1. VISUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (M'l'G) [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 6. VADOSE ZONE ,~ 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] 7. GROUNDWATER ! [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 8. TANK TESTING BIENNIAL TANK TESTING [] 99. OTHER V. TANK CLOSURE INFORMATION t PERMANENT CLOSURE IN PLACE . ESTIMATED DATE LAST USED (YPJMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE RE MAINING 458 TANK FILLED WITH INERT MATERIAL? 457' .gallona [] Ye~ [] NO PCF (7/99) S:\CU PAFORMS\SWRCB-B.WP D CITY OF BAKERSFIELD / I OFFICE OF ENVIRONMENTAL SERVICES ~ ,, Chester Ave., Bakersfield, CA 93301 (661) 32(I~1~'9 UST. TANK , VI, PIPING CONSTRUCTION (Check a8 ~hat apply) UNDERGROUND PIPING ~ ABOVEGROUND PIPING SYSTEMTYPE~ 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 i [] I. PRESSURE [] 2. SUCTION [] 3. GRAVITY CONSTRUCTION/ []. t. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 I [] 1. SINGLE WALL E~ 95. UNKNOWN 462 MANUFACTURER;~2. DOUBLE WALL [] 95. UNKNOWN !~"~ 2. DOUBLE WALL [] 99. OTHER ' MANUFACTURER 461 L MANUFACTURER 463 :r-I 1. BARE STEEL [] 8. FRP COMPATIBLE WI 100% METHANOL I [] I. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL MATERIALS AND ![] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL CORROSION ' PROTECTION i []' 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99. OTHER ~4. FIBERGLASS .t'-~ 8. FLEXIBLE (HOPE) [] 99. OTHER I [] 4, FIBERGLASS [] g. CATHODIC PROTECTION ir'-I $. STEEL W/COATiNG [] 9. CATHODIC PROTECTION 464 [] 5. STEEL W/COATING r"'] 95. UNKNOWN 465 "" ' ' VII, PIPING EEAK DETECTION (Check alt ~at apply) UNDERGROUND PIPING' ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check alt ~hat apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK~ LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION * AUDIBLE AND VISUAL ALARMS ALARMS l--] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRFI"Y TEST (0,1 GPH) [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) i [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: . CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5, DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PiPiNG INTEGRITY [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) I [] 6, TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PiPiNG): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9, BIENNIAL INTEGRITY TEST (0.1 GPH) [] 8. DALLY VISUAL MONITORING [] ~. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING ~ SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): I PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (ChecX one) "I 10. CONTINUOUS TURBINE SUMP SENSOR WiTH AUDIBLE AND VISUAL ALARMS AND (ched(one) j~v;I AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] B. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NOAUTO PUMP SHUTOFF [] c. NOAUTO PUMP SHUT OFF ~ 11, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST} WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL iNTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check alt that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15. AUTOMATIC LINE LEAK DE'rECTOR {3 0 GPH TEST) W~THOUT_ FLOW SHLFF OFF OR El. 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16, ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DALLY VISUAL CHECK DISPENSER CONTAINMENT '~ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ,~ 4. DALLY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING [] 3. CONTINUOUS DISPENSER PAN SENSOR WIT.H AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE I certify that the infomlation proviOed herein Is true and accurate ID Ihe best of my knowledge. JPCF (7/99) S:\CU PAFORMS~SWRCB-B.WPO , CITY OF BAKERSFIELD OFF~ OF ENVIRONMENTAL SI~. ICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ~. · ' UNDERGROUND STORAGE TANKS - TANK PAGE 1 TYPE OF ACTION ~ t. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5, CHANGE OF fNFORMATION} r~l 8. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE i Check one from only) ~. RENEWAL PERMIT (Spec~ mason, lot local use only) (Specify change - for local use only) [] 8. TANK REMOVED 430 LOCATION WITHIN SITE (Optional) 43 I. TANK DESCRIPTION TANK ID # 432 ;, TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes 434 'bATE INSTALLED (YEAPJMO) 435 i T~'~-~PACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 ADDITIONAL DESCRIPTION (For local use only) 438 II. TANK CONTENTS TANK USE 439 PE'rROLEUM TYPE 440 1. MOTOR VEHICLE FUEL [] la, REGULAR UNLEADED [] 2. LEADED [] 5, JET FUEL (If marked, complete Petroleum Type) ~ lb. PREMIUM UNLEADED ~ 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIOGRADE UNLEADED [] 4. GASOHOL [] ~J. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (f~om Hazan:lou$ Mafodals lnventoly pa~e) 441 i CAS # (f/Om Hazardous Materials Inventory page) 442 [] 4. HAZARDOUS WASTE (includes ~ Used Oil) 0 '"- [] 95. UNKNOVVN ~ ~-'~ ~'~'- ~ ~ ~ ~ · . . III, TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WTTH INTERNAL BLADDER SYSTEM 443 EXTERIOR MEMBRANE LINER [] 95. UNKNOWN !Check one item only) ~2. DOUBLE WALL [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL - primary tank [] 1. BARE STEEL ~ 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 4~4 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE WI100% METHANOL [] 99. OTHER REINFORCED PLASTIC (FRP) rANK MATERIAL - secondary tank [] 1. BARE STEEL ~3. FIBERGLASS / PLASTIC [] 6. FRP COMPATIBLE W/100% METHANOL [] 95. UNKNOWN 445 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FPP NON-CORRODIBLE JACKET [] ~9. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE rANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING ,~95. UNKNOWN 446 DATE INSTAU_ED 447 :)R COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] 6, UNLINED. [] 99. OTHER __ 'Check one #em ~nl, Y) (For local usa :)THER CORROSION [] 1. MANUFACTURED CATHODIC ~, 3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 DATE INSTALLED 449 =ROTECTION IF APPLICABLE PROTECTION [] 4, tMPRESSEDCURRENT r-~99. OTHER 'Check one item only) [] 2, SACRIFICIAL ANODE (For local use only) ~PILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 1F $1NGLE WALL TANK (Check alI that apply): 453 IF DOUBLE WALL TANK OR TANK WlTH BLADDER (Check one item only): 454 [] 1. VISUAL (EXPOSED PORTION ONLY) r-] 5. MANUAL TANK GAUGING (MTG) [] t. VISUAL {SINGLE WALL IN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 15, VADOSE ZONE ~ 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] 7. GROUNDWATER , [] 3, MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 8. TANK TESTING BIENNIAL TANK TESTING [] 99. O'I~HER V, TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE . ESTIMATED DATE LAST USED (YPJMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? ~t57 gallo~s [] Yes [] NO ................................................ PCF (7~99) S:\CUPAFORMS\SWRCB-B.WP O CITY OF BAKERSFIELD ~ ./ OFFICE OF ENVIRONMENTAL SERVICES t~ ~hester Ave., Bakersfield, CA 93301 (661) 326-~9 UST. TANK , ~. PIPING CONSTRUC~ON (~ck aa ~t ABOVEGROUND PIPING UNOERGROUND PIPING SYSrEM~PE ~. PRESSURE ~ .2. S~gTI?~' . U 3. G~VI~ 450 ................................ ;U I. PRESSURE ~ 2. SUCTION ~ 3. G~VIW CONSTRUCTtONI ~ 1. SINGLE WALL ~ 3. LINED TRENCH ~ ~. O~R 4~ I ~ ~' S~NGLE WALL ~ 95. UNKNOWN 462 ~NUFACTURER;~2. ~UBLE WALL ~ 95. UNKNOWN ~ ~ 2. DOUBLE WALL ~ 99. OTHER ' ~NUFACTURER .......... ~_.~_ ~NUFACTURER 463 :~ 1. BARESTEEL ~ 6. FRPCOMPATIBLEW/I~%ME~NOL {~ 1. BARESTEEL ~ 6. FRPCOMPATIBLEW/I~%~THANOL ~TER~ALS AND ~ 2. STAINLESS STEEL ~ 7. ~LVANIZE~ STEEL ~ 2. STAINLESS STEEL ~ 7. GALVANIZED STEEL CORROSION ' PROTECTION j~' 3. P~STIC COMPATIBLE WITH CO~S ~ 95. UNKNO~. ~ 3. P~STIC COMPATIBLE WITH CONTENTS ~ 8. FL~IBLE (HDPE) ~ ~. OTHER ~ ~ 4. FIBERG~SS ~ g. ~THODIC PROTECTION 4. FIBERG~SS ~ 8. FL~IBLE (HDPE) ~ 99. OTHER ~ ~ 5. S~EL W/COATING ~ 95. UNKNO~ 465 ~,~ 5. STEEL W/COATING ~ 9. ~THODIC PROTECTION 4~ ~ '"" ' ' ~l. PIPING L~K DETE~ION (C~ck afl ~at UNDERGROUND PIPING' ABOVEGROUND PIPING SINGLE WA~ PIPING 466 ; SINGLE WA~ PIPING 467 PRESSURIZED PIPING (Check all that app/y): PRESSURIZED PIPING (Chec~ a// ~at apply): ~ 1. ELECTRONIC LINE L~K DETECTOR 3.0 GPH TEST WITH AUTO ~MP SHUT OFF FOR ~ 1. ELECTRONIC LINE L~K DETE~OR 3.0 GPH TEST WIT~ AUTO PUMP SHUT OFF FOR L~ L~K. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE ~D VISUAL SYSTEM FAILURE. AND SYS~M DISCONNECTION + AUDIBLE AND VISUAL A~RMS ~ 2. ~LY 0.2 G~ TEST ~ 2. ~LY 0.2 GPH TEST ~ 3. ANNUAL I~EGR~ TEsT (0.1 GPH) ~ 3. ANNUAL I~EGR{~ TEST (0.I G~) ~ ~ 4. DAILY VISUAL CHECK CO~ENTtONAL SUC~ON SYSCO: ~ CO~E~O~L SUC~ON SYS~ (Check all that a~ply): 5. DALLY VISUAL ~N~ORING OF PUMPING SYSTEM + ~IENNIAL PIPING I~EG~ 5. DALLY VISUAL ~NITORING OF PtPING AND PUMPING SYS~M TEST (0.1 GPH) ~ ~ 6. TRIENNIAL I~EGRI~ ~ST (0.1 GPH) SAFE SUCTION SYSTE~ (NO VALVES IN BELOW GROUND PiPiNG): SAFE SUCTION SYSTE~ (NO VALVES IN BELOW GROUND PIPING): ~ 7. SELF ~NITORING ~ 7. SELF ~N~ORING G~V~ FLOW: G~VI~ FLOW (Check a/t ~at apply): ~ 9. BIENN~L I~GR~ ~ST (0.1 GPH) ~ 8. DALLY VISUAL ~N~TORING ~ 9. BIENNIAL I~GRI~ST(O.1 GPH) SECONDARILY CO~NED PIPING SECONDA~LY CO~NED PIPING PRESSURIZED PIPING (Check all that appty): PRESSURIZED PIPING (Che~ all ~at apply): 10. CO~INUOUS TURBINE SUMP SENSOR ~ AUD[BLE ~D V~SUAL A~R~ AND (~ ~e) 10. CO~INUOUS TURBINE SUMP SENSOR ~ AUDIBLE AND VISUAL ~R~ AND (~ ~e) ~ :: AUTO PU~ SHUT OFF ~EN A L~K OCCURS . ~ a. AUTO PUMP SHUT OFF ~EN A L~K OCCURS AUTO PU~ SHUT OFF FOR L~KS. SYSTEM FAILURE AND SYSTEM ~ b. AUTO PUMP SHUT OFF FOR LEAKS. SYS~M FAILURE AND SYS~M DISCONNECTION DISCONNECTION ~ c. NO AUTO PUMP SHUTOFF ~ c. NO AUTO PUMP SHUT OFF ~ 11. A~O~TIC LINE L~K D~ECTOR (3.0 GPH TES~ W~H ~OW SHUT OFF OR ~ 11. AUTO~TIC L~K DETECTOR RESTRICTION ~ 12. ANNUAL I~EGRI~ TEST (0.1 GPH) ~ 12. ~NUAL I~EGR~ ~ST{0.1 GPH) SUCTJO~G~VI~ SYSTEM: SUCT~G~VJ~ SYS~M: ~ 13. CO~INUOUS SU~ SENSOR + AUDIBLE ~D VISUAL A~R~ ~ 13. CO~INUOUS SU~ SEN~R + AUDIBLE AND VISUAL A~R~ EMERGENCY GENE~TORS ONLY (Check all ~at app,) EMERGENCY GENE~TORS ONLY (Check all ~at app/y) ~ 14. CO~INUOUS SUMP SENSOR WITHOUT AUTO PU~ SHUT OFF · AUDIB~ AND ~ 14. ~NTINUOUS SU~ SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL A~RMS A~MS ~ 15. AUTO~TIC LINE L~K D~ECTOR (3.0 GPH ~ST) ~THO~ FLOW SH~T OFF OR ~ 15. AUTO~TIC LINE L~ D~ECTOR [3.0 GPH ~ST) RESTRICTION ~ 16. ANNUAL ~NTEGRI~ TEST (0.1 GPH) ~ 16. ANNUAL I~EGRI~ TEST {0.1 GPH) ~ 17. DAILY VISUAL CHECK ~ 17. DAILY VISUAL CHECK .... ~ .. ". *:~.:~ :~'~[~.:~.~-'.~*'~:~:.***'-~'~'~.'~?~:~ .~II:DISPENSER CONTAINMENT '~...: .:. .. ~ '*t . ~ .. OISPENSER CO~AIN~ ~ 1. FLOAT MECH~ISM THAT SHUTS OFF SH~R VALVE ~ 4. OAILY VISUAL CHECK DATE INSTALLED 4~ ~ 2. CO~NUOUS DISPENSER PAN SENSOR + AUDIBLE ~D VISUAL ~R~ ~ 5. TRENCH LINER / ~NITO~]NG ~ 3. CO~INUOUS DISPENSER PAN SENSOR WlT~ AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL A~ ~ 6. NONE ~9 I~ OWNE~OPE~TOR SIGNATURE I c~i~ thai Ihe inf~allon provid~ her~n Is lme and ~rate to the b~t of my kn~ge. S'~N~O~E~OPE~TOR ~~~ '-'~'~"----'~~ ~i~L~_~ ....................................................... ~. ~ ................................................ ~i~- P~it Numb~ ~r ~Ce/ use Only) 473 ~ Pe~ll ~prov~ (~r ~cal use only) 474 Paoli ~piratl~ Date (~r local use only) 475 JPCF (7/99) S:~CU PAFORMS~SWRCB-B.WPD LINE R]:-ENA]3LE METHOD ]>ASS L[NE TFST LINE PER EST NEEDED kIRN ~OFTI,~IARE REVISION LEVEL -- -DISABLED VERSION 121.00 LINE ANN TS'[' NEEDED WRN f~OFTL4ARE~ ~46121 - l O0-A ]) I SABLED CREATED - 00,11,15.18.23 PRINT TC ~OLUMES f~-MODULE~ ~:~0160-162-A ]) I SABLED ~UTO TRANSM IT SETT f{YSTEM FEqTURES: PERIODI3 [N-TANK TESTS UEMP COMPENSATION ~UTO LEAK ALARM LiMI~ ANNUAL IN-TANK TESTS ~ALUE ~DE3 F ): 60,0 DISABLED CSLD f~TICK HEI3HT OFFSET ~UTO HIGH WATER LIMIT B I R D I SABLED ]. I oABLED ~ _FUEL_MANAGER ~UTO OVERP ILL L I M I T PLLD H-PROTOCOL DATA FORMAT ])ISABLED 0.10 AU[O HEIGHT ~UTO LOW PRODUCT 0.20 REPETITIV PRECISION TEST DURATION ])ISABLED UPLLD HOURS: 12 ~UTO THEFT LIMIT 0,10 AUTO 0.20 GPH LINE TEST DISABLED 0.20 REPETITIV AUTO-CONFIRM: ENABLED ~UTO DELIgERY START 0,10 GPH LINE TEST ])ISABLED ~UTO-CONFIRM: ENABLED '-- AUTO DELI ~ERY END ~'])AYLIGHT ~AVING TIME ])ISABLED ENABLE]) AUTO E~<TERNAL INPUT ON f~TART DAT~ ]) ISABLED APR NEEK [ SUN ~UTO EXTERNAL INPUT OFF f~TART T I ME ]) I SABLED 2:00 AM ~UTO SENSOR FUEL ALARM END DATE I)ISABLED OCT [4EEK 6 SUN AUTO SENSDR WATER ALARM f{YSTEM SE[UP END TIME 1) I $ABLED .............. 2:00 AM .: ~UTO SENSOR OUT ALARM ['IAR 18. ~00:3 7:$8 AM DISABLED RE-DIRECT LOCAL PRINTOUT- ]) I SABLED ,:YoTEM UNIT,~ EURO PROTDCOL PREFIX ~YSTEM LANGUAGE E NGL I f{ H f~YSTEM DAFE/TIME FORMAT ~ON DD VVgY NH:MM:SS xM ~YSTEP1 SE3URITY =. l) 8:VEEDER ROOT (FM$) .2?822 TENA ~0 ]~CVR TVPE: COMPUTER ,(. CODE : 000000 (~ALL 40000100~5 ;~621 CALIF. AV. PORT NO: 6 BAKERSFIELD CA 98809 RETRY NO: 5 '2101715050500] ]~ETRY ])ELqY: 5 SHIFT TIME [ 5:00 AM CONFIRMATION REPORT: OFF f~HIFT TIME 2 DISABLED ~HIFT TIME :~ DISABLED f~HIFT TIME 4 DISABLED f~HIFT BIR PRINTOUT$ ]) I $ABLED COMMUN [ CAF ION$ SETUP ])AILY ]~IR PRINTOUTS ]) I $ABLED .............. "I CKETED DEL I VERY ENABLED PORT SETTINGS::' '70 TICKETED DELIVERY . ,, ,. ~U?O DIAL TIME SETUP: ])ISABLED COMM BDARD 1 (RS-2J2> CLOSE DAY OF WEEK - BAUD'R:ATE, 1200 PARITY ' ODD ]) 8 :VEEDER ROOT (EMS) ])ALLY ])LUg VAR RPTS S~OP ]RIT 1 STOP DIAL ON DATE D I SABLED ' DATA LEN3TH: 7 DATA [~AR 10. 200:3 UEEKLY DL~Y VAR RPT$ ]~B-282 $EJURITV ": ])IAL TIME : $:50 PM ])IS~BLED CODE : 000000 RECEIVE~ ~EPORTS: PERIODIC DLVV V~R RPTS ]) I$~BLED COMM BOARD :'~5 ])~ILY BOOK V~R ~PTS ~UD R~TE : 2'400 ]) I S~BLED P~R I TY : EVEN .... UEEKLY BOOK V~ RPTS STOP BIT : 1 STOP ])I$~BLED D~T~ LENGTH: 7 D~T~ ' ]>ERIOD[C BOOK V~R RPT$ ]~S-282 $E3URITV ])I$~BLED CODE : 000000 DAILY VAR ANALY RPTS DISABLED COMM BOARD 6 ~$-$AT tJEEKLY VAR ANALV RPT~ BAUD RATE 9600~ D I SABLED PAR I TY ODD ]>ERIODtO ~AR ANALV RPT$ STOP ]BIT 1 STOP DISABLED DATA LEN3TH: ? DATA - TANK PER FST NEEDED WRN ]~S-~$~ SEJURITV '. ~ l~S-232 END OF MESSAGE DISABLED CODE : 000000 ' ,, , DISABLED '?ANK ANN TST NEEDED kIRN DTR NORMAL STATE:, H~,Gfi .:, DISABLED ' . ,,,~, AUTO DIAL ALARM SETUP 2: 89 PLUS i:>RODUOT OODE : 2. '?HERMAL OOEFF : , 000700 '?ANK D [ AMET]-.:R : 89.75 ':ANN PROFILI-: : 4 PTS ........ - FULL VOL : 972..8 "1:87 RE.2 67. :3 IN3H VOL : 7876 44,9 IN3H VOL : 4904 PRODUCT COD]: 1 22 4 INOH VOL : 1898 ':HERMAL COE]-'F .000700 · ........................... '?ANK D[AMETFR 89.75 IIETER DAT~ : NO l) 8:VEI-'DER ROOT (FMS) '?ANK PROFILF 4 PT8 FULL VOL 1162.7 4.0 IN. 'N-TANK ALARMS 67.8 IN3H VOL 9862 FLOAT :3IZE: ALL:L:AK ALARM ~4~.9 IN~M VOL 5836 0.8 ALL:MIGH WATER ALARM _ .4 INOH VOL 2271 WATER WARNING : ALL:OVERFILL ALARM P1ETER DAT~ NO 14IGM WATER LIMIT: 1.5 ALL:SUDDF. N LOSS ALARM I'IAX OR LABEL VOL 972.8 ALL:M[GM PRODUCT ALARM OVERFILL LIMIT 94~ ALL:INVALID FIJEL LEVEL FLOAT ~3IZE: 4.0 IN, 9144 ALL :PROBS <)UT HIGM P]~ODUCT ALL:M[GM W~TER WARNING UATER WARNING :0.8 9436 ALL:MAX PRODUCT ALARM HIGM WATER LIMIT: 1.5 DELIVERY LIIqlT ALL.GRO.~ '['EST F~IL 1452 ALL:PERIODIC TEST FAIL PlAX OR LA~EL VOL 116'27 ALL:ANNUaL TEST FAIL OVERFILL LIPIIT 93~g 500 ALL:PER TST NEEDED WRN 10813 ].OM PRODU3T : ALL:PER 1'ST NEEDED ALM HIOM P]90DUCT 96~ LEAK ALAR'I LIMIT: ALL:NO C~L].') IDLE TIME 11162 !.~UDDEN LO~$ LIMIT: 50 ALL:CSLD INCR RATE WARN DELIVERY LIMIT 14~: 'TANK TILT : 1.67 ALL:ACCU_CHART CAL WARN 1729 1,1ANIFOLDED TANKS ALL :R]F. CON WARNING ','~t: NONE ALL:RFCON ALARM LOW PRODUOT : 500 ALL: LOW 'FEI'IP WARN I NG LEAK ALAR"I L I M I T: ALL:OROS~ FAIL LINE TNK ~ ~:UDDEN LO-3S LIPIlT: 50 0% UANK TILT : 0.82 LEAK M[N PERIODIC: : 0 ].I~3UID SENSOR ALM~ ALL :FUEL ALARM \ ~IANI FOLDED TANK8 0% ALL S]-'N8OR OUT ALARM '?~t: NONE LEAK M IN ~NNUAL : : 0 ALL SHORY ALARM ALL WATER ALARM ALL WATE~ <)UT ALARM LEAK M[N PERIODIC: O~ PERIODIC -FE}BT TYPE ALL FI[GM L[(~UID ALARM : 0 STANDARD ALL :LOW LI~UID ALARM ALL:LIqUID WARNING LEAK M[N qNNIJAL : : 0 j:NNU~L TEBT FAIL ~L~RM DI~BLED RECEIVER ~LARM8 PERIODIC YE~:T F~IL SERVICE ~EPORT W~RN PERIODIC YE}BT TYPE ~L~RM DIG~BLED ~L~RM CLEAR W~RNI NG ~ 8T~ND~RD I>RE~SURE LINE LEAK ,,/ ~NNLIAL TE3T FAIL GROSS TE~T ]:AIL ALL :GROSS LI NE FAI'L ALARM DISABLED ALARM DISABLED ALL:ANNUAL LINE F~IL [E,~T FAIL ALL PER TS'[ NEEDED ALM PERIOD[O ' ~' ~NN TE~T ~VERAGING: OFF ALL PLLD OPEN ALARM ALARM DISABLED PER TE~T AVERAGING: OFF ALL UNKNOWN ALARM 'TANK TEST NOTIFY: OFF ALL UNKNOWN ALA~P1 GROSS TES~ ]:AIL ALL UNKNOWN ALARM ~LRRH DISABLED 'TNK TST SIPHON BREAK:OFF ALL:PERIODIC LINE FAIL ALL:ANN FS'F NEEDED RLPI ~NN TE~3T qVERRGING: OFF <- ])ELIVERY DELAY : 3 MIN ~L,L :LO~ PRESSURE aLaRN PER TE,~T ~VERaGI NO: OFF ALL: UNKN0~N ALARN aL.L:OONT HANDLE RLN UaNK TEST NOTIFY: OFF ALL :FLIEL 01JT RLL:LN E3U[P FAULT RhN UNK TST SIPHON BREaK:OFF ])ELIVE]gY DELAY : 8 NIN "3;91 PREM ]~RODtJCT COD]--: 3 '?HERMAL COEFF .000700 'TANK D[AMBTFR 89.75 iN-TANK ~F. TIJP 'TANK PROFILF 4 PT~3 FULL VOL 9728 67,~ IN3H VOL 7876 44.9 IN3H VOL 4904 2~.4 IN3H VOL 1898 I~ETER ])AT~ NO "4:DIESEL TEST CSLD : ALL TANK ]~RODUCT f~0DF 4 THERMAL COEFF .000450 ]>d = 9'9% : TANK DIAMETER 89.75 ()LIMATE FACTOR:MODERATE "~:DIESEL I TANK PROFILE 4 PT$ ~R0S$ TEST ' FULL VOL 9728 ~%t/G S~].ES-SUN 144 67.3 INgH VOL 78?6 ~%UTO-CONFIRI.'J: DISABLED ~%VG S~].ES-MON 209 G~L ~%VG S~].ES-TIJE 197 44.9 IN3H VOL 4904 ]~EPORT ONLY: ~%VG $~].ES-~ED 217 ):'LO~T ~IZE: 4.0 IN. 22.4 INgH VOL 1898 I~ETER ])~T% NO ~%VG S~].ES-THR 217 ~L ~%VG S~].ES-F]~ I 289 ~,I~TER [0~RNIN~ : 0.8 'TST E~RL¥' STOP:DISaBLED ~%VG S~LES-S~%T 120 HIGH ~4ATER LIMIT: 1.5 FLO~T ~{IZE: 4.0 IN. ].E~K TEST REPORT FORMAT ~D,W OR L~SEL VOL: 9728 NORMAL OVERFILL LI~qIT : 94~.~ [~TER [O~RNING : 1 .0 : 914~ HIGH [,dATER LIMIT: 2.0 ]>RESSU]~E LINE LE~K S,ETUP I{I~H PRODUCT : 97% : 9486 JfiAX OR LABEL VOL: 9728 DELIVEJ~y LI~IT : 14~.~ OVERFILL LI~4IT : 1452 9144 (J 1:87 HIGH PRODUCT ].Oki PRODU3T : 500 9436 'TVP:2.0/3.0[N FIBERGLASS LE~K ~].~R~ LIMIT: $ ])ELIVERV LIIqlT 1~% 2.0IN ])I~ LEN:i~0 FEET ~UDDEN LO~$ LIMIT: 50 1452 :~.OIN DIA LEN: 0 FEET _ , I].20 6PH FEfST: REPETITIV ~].10 GPH YES,T: AUTO TANK TfLT : 0.50 LOW PRODLI[:T : 500 27822 TE~',AC:O f~HUTDOi~IN RATE: 3 O GPH ['IANIFOLDED TANKS I.EAK ALAR~ LIMIT: 2 ' '~: NONE f:UDDEN LOSS LIMIT: 50 :~621 CALIF. AV. ].0~4 PRI:S,~[RI: SHUTOFF:NO I TANK TfLT : 3.12 I~AKERSFIELD OA 93809 LOW PRESSURE : 0 PSI ;~1 O171~50505J]01 , "1:87 RES LEAK MfN PERIODIO: O~ ~ I~ANIFOLDED TANKS I~AR 18. 2005 7:89 AM DISPENf~E : 0 .~ '~: NONE STANDARD LEAK M[N ANNUAL : O~ FUEL P1ANAJEMENT SETUP f~ENSOR: NON.-VENTED : 0 LEAK PI[N PEI~IODIO: O~ .............. I>RESSU]~E OFFSET: O.OP~I ~ : 0 DEL I VERY ~A]~N DAYS: O. 0 ]>ERIOD[O FEfST TYPE LEAK M[N ~NNUAL : 0~ ~UTO PRINT: DISABLED STANDARD : 0 ~NNUAL TEST FAIL '~ 1:87 RES ALARM DISABLED ]>ERIOD[O :EST TYPE ~VG SALES-SUN: 8846 GAL STANDARD ~VG $ALES-MON: 8446 GAL ]>ERIOD[O TEST FAIL ~WG SALES-TUE: 8272 GAL ALARP1 DISABLED ~NNUAL TEST FAIL ~VG $ALE$-[~ED: 8430 GAL ALARM DISABLED ~t/G ~ALE~-TNR: 35S4 GAL ~R0S$ TESF FAIL :. ~VG $ALES-FRI: 4401 GAL (~ 2:89 ALARM DISABLED PERIODIC FE~:T FAIL ~VG SALES-SAT: 8408 GAL ALARM DISABLED <- 'TYP:2.0/8.0[N FIBERGLASS ~NN TE,~T AVERAGING: OFF PER TEf~T AYERA~IN~: OFF (~R055 TEST FAIL -~ 2.0IN DIA LEN:155 FEET . ;~,OIN DIA LEN: O FEET ALARM DISABLED '~ 2:89 PLUS/ ii.20 GPH TEST REPETITIV TANK TEST NOTIFY: OFF ~NN TEfST'AtERAc:IN~.~ ..... OFF ~VG SALES-SJN.~' -' I · 580 GAL f~HLITDO[YN iI' 10 GPH RATE:EJ~T AUTO$.O GPH 'TNK TST SIPHON BREAK:OFF PER TEfST AVERAGING: OFF ~:VG ~ALES-MON: 480 GAL LOW PRESSURE SHUTOFF:NO ~¥G ~ALE$-TUE: 492 GAL LO~ PRE$SLIRE : 0 P~I DELIVERY DELAY : S MIN TANK TEST NOTIFY: OFF ~VG $ALES-t4ED: 482 GAL 'TNK TST SIPHON BREAK:OFF ~VG SALES-TIeR: 550 GAL "2:~9 PLUS ~VG SALES-FIJI: 621 GAL DISPENSE ~ODE: ])ELIVE]~Y DELAY : 3 PIlN ~VG SALES-SAT: 567 GAL STANDARD f:ENSOR: NON-VENTED : ]>RESSLIRE OFFSET: O.OP$I '~ 8:91 PREM , ~t~ ~ALE~-SUN: 458 GAL~ ~V~ ~ALES-IION. $S5 GAL' ~V6 SALES-TUE: 421 GAL ~VG SALES-WED: $88 GAL{ ~VG $ALES-TI4R: 422 GAL{ ~VG $ALE~-FRI: 5SJ GAL~ ~VG SALES-S~T: 405 ~ ~ _ _ LEAK TE~T ~IETHOD ~--- LIgUID SENSOR ALMS _ _ t: 3:91 L 4:89 STP SUMP L 4:FUEL ALARM ~ ~-27822 TE<ACO 'TRI-STATE (~3INGLE FLOAT) L 5:FUEL ALARM '?YP:2.0,,'S,0[N FIBERGLASS CATEGORY : STP SUMP L 6 FUEL ALARM 3621 CALIF. AV. 2.0IN ])IA LEN 170 FEET L 4 SENSOR OUT ALARM BAKERSFIELD CA 93809 :~.OIN ])IA LEN 0 FEET L 5 SENSOR OUT ALARM '.~10171%50505001 ).=0 GPH FE.~T REPETITIV L 5:89 FILL SUMP L 6 SENSOR OUT ALARM 0,10 GPH YEAST: AUTO 'TRI-STATE (~INOLE FLOAT) L 4 $HORI ALARM HAR ~8, 20~:3 7:46 AM ~HUTDOWN ~ATE: $.0 GPH GATEGORY : OTHER SENSORS L 5 $HOR: ALARM LOW PRESSURE SHUTOFF :NO L 6:SHORF ALARM LOW PRESSURE : 0 PSI PRESSURE LINE LEAK SYSTEM ~TATUS REPORT "~:91 PREM ], 6:89 ANNULAR &q 2:PLLD OPEN ALARM .............. ])ISPEN~{E ~O])E: 'TRI-STATE <~INGLE FLOAT) Q 2:CONT HANDLE ALM ALL FUNOT[ON$ NORMAL STANDARD CATEGORY : ANNULAR SPACE ~ 2:LN E~U[P FAULT ALM ~ };ENSOR: NON-VENTED PRESSURE OFFSET: 0,0PSI ........ (~ 8:91 L 7:91 STP SUMP 'N-TANK ALARMS 'TRI-STATE (~3INGLE FLOAT) T 3:HIGH WATER ALARM (;ATEGORV : ~3TP SUMP T 3:LOW PRODUCT ALARM LI¢~UID SENSOR ALMS L 8:91 FILL SUMP L 7:FUEL ALARM ]:'RESSURE LINE LEAK ALARM '?RI-STATE (SINGLE FLOAT) L 8:FIJEL ALARM L 9:FUEL ALARM ]>LLD $HUTDOWN ALARM CATEGORY : OTHER SENSORS L 7:SENSOR OUT ALARM HAR 18. 200:3 7:56 AM L 8:$ENSOR OUT ALARM L 9:SENSOR OUT ALARM (~ ~:DBL L 9:91 ANNULAR L ?:$HO~F ALARM '7RI-BTATE <SINGLE FLOAT) L 8:$HO~: ALARM 'TYP:2.0/3.0[N FIBERGLASS CATEGORY : ANNULAR SPACE L 9:SHORT ALARM 2.0IN ]}IA LEN:185 FEET .,, J,OIN DIA LEN 0 FEET ]>REBSURE LINE LEAK 0.20 G])H FE~T REPETITIV ~ S:PLLD OPEN ALARM 0.10 GPH FEST AUTO I~O:DSL BFP SUMP ~ S:OONT HANDLE ALM ...... SENSOR ALARM ..... ~HUTDOWN RATE 3.0 GPH 'TRI-STATE (~INGLE FLOAT) g S:LN E3U[P FAULT ALM LOW PRESSURE SHUTOFF:NO L 1:87 STP SUMP LOW PRESSURE : 0 PSI CATEGORY : STP SUMP (~ 4:DBL ~)TP 8UPlP FUEL ALAR'I "4:DIESEL LIi:DSL FILL SUMP iN-TANK ALARMS lIAR 18, 2009 ?:56 AM ])ISPEN~3E '40])E: 'TRI-STATE (~INGLE FLOAT) T 4:HIGH WATER ALARM STANDARD CATEGORY : OTHER SENSORS T 4:LOW PRODUCT ALARM ~ENSOR: NON-VENTED PRESSURE 0FFSET: O.0P$I LIQUID SENSOR ALMS LIO:FUEL ALARM ]~12 :DBL ANNULAR L11 :FUEL ALARM 'TRI-STATE (SINGLE FLOAT) L12:FUEL ALARM CATEGORY : ANNULAR BPAOE .27822 TEKAOO :~621 CALIF. AV. BAKERSFIELD CA 93909 2101 ?150505001 IlAR 18. 2003 8:00 AM CSLD TEST RESULTS LINE LEAK LOCKOUT SETUP ............... .............. RECONC[LI~T[ON SETUP liAR 18. 200:3 8:00 AM LOCKOUT S3MEDULE .............. DAILY ~,.~TART TIME: DISABLED ]>LLD LINE DISABLE SETUP "1:87 RES ~TOP TIME : DISABLED .............. ~UTOMATIC DAILY CLOSING ]~ROBE ~ERIA], NUM 019251 '7IME: 2:00 AM (~ 1:87 0 '~ GAL/HR TE$T AUTO BHIFF ~1 OLO$ING 'N-TANK ALARMS '7IME: DISABLED ]>ER: MAR 18. 200~ T I:H[GH WATER ~L~RM T i:LOW PRODUCT ALARM ~UTO $HIFY :~2 CLOSING "2:89 PLUS TIME: DISABLED ]~ROBE SERIAL NUM 189108 LIQUID BENBO~ ALMS L I:FUEL ALARM ' ~UTO SHIFY :~$ OLO$ING 0.= ~ GAL/HR TEST L 2:FUEL ALARM -IME: ])I$~BLED PER: MAR 18. 2003 PASS L S:FUEL ALARM LIQUID SENSOR SETUP h I:$EN$OR OUT ALARM AUTO $HIFF :~4 CLOSING .............. h 2:SENSOR OUT ALARM -IME: 5:00 AM ~' ~:91 PREM L $:$ENBOR OUT ALARM ]~ROBE ~ERIAL NUM 018607 (. L 1 :SHOR~ ALARM L 1:87 $TP ,)UMP h 2:$HORF ALARM ]>ERIOD[O RECONCILIATION ?RI-BTATE (SINGLE FLOAT> 0 GAL..zHR TEST CATEGO]W : STP SUMP L $:SHORF ALARM HODE: MONTHLY ALARM: DI$ABLED PER: MAR lB. ]>REBBURE LI NE LEAK L 2:87 FILL BUMP ~ I:PLLD OPEN ALARM TEMP OOMPEN~BATION ~' 4:DIESEL 'TRI-STATE (SINGLE FLOAT) ~ I:CONT HANDLE ALM ~TANDARD ]{~OBE SERIAL NUM 019252 CATEGORY : OTHER $EN$OR~ g 1 :LN E~U[P FAULT ALM ~IETER CALIBRATION OFFSET: 0. 000~<~ 0.2 GAL/HR TEST (~ 2:89 PER: MAR 18 ~OOB BUS BLOT FUEL METER TANK ' I. 8:87 ANNULAR ] N-TANK ALARM$ ............... TRI-STATE (~IN~LE FLOAT] T 2:HiG~ WATER ~L~RM TANK MAP EMPTY CATEGORY : ANNULAR $PAOE_ T 2:LOW PRODUCT ALARM